The Making of a Woman Intensivist: Age 2

 / by Dr Margaret Aranda /

Image 1. Awakening. There was no 'gradual' awakening.  

Photo CreditMasopasi/iStock/Getty Images

Her eyes opened, wide awake in a microsecond. Darting them about, "Oh boy!" ...it dawned on her like a firecracker that today wa...."OH! I wanna go out and play all the whole day away!"

She woke up more, immediately with another quick flash.  "Oh!" Determination was sharply set on her smooth face and her lips perked up, straightened. Wide awake, the little two-year old toddler hurriedly threw the soft cuddly blankets back, sun-drenched room bright, smile in flight. Her orange night-light was still on, for some reason, and the lavender fragrance sheets spoke of things colored and flowery.  

Since her blue gray pajamas were all knitted with dreams of cloud-watching, that was the last thing on her mind. It was the long zipper from neck to ankle and the yellow feet that did it. For they were pleated and padded on the bottom with that sticky pad kind of stuff. And she wanted out of bed now. 

Rolling over on her stomach, she positioned her body perpendicular to the needless bed.  She meticulously laid her head on the middle of the bed, then scooted her legs so they flipped over the edge.  This was the challenge of the day: to get past the edge of the bed. To get to greater things that were unseen. She had to do it! Her lips pursed once again as she breathed out of her nose. She laid on her belly, then grabbed onto the bedsheets with her little hands tightly clenched. Her knuckles were indented with that baby fat we all love, chunky wrists with folds of laughter and kisses to behold.  

At first, her feet dangled over the edge, she let herself slowly fall down in a controlled way. Now her knees were on the edge.  One hand loosened grip and moved closer to the edge, too.  Her hips pushed on the edge of the bed. Now both fists were white at the knuckles.  Slowly, ever so slowly, she let gravity pull her down.  The edge of the bed was at her belly now. Her feet swung from the bed, and they inched down.

"Uh!  Uh!"  She grunted as her eyes looked backwards.  She looked backwards so hard that her eyes hurt.  It was morning again and she just had to do it!  "Uh!"  She couldn't wait!  She had to get out of this bed!
"Bam!"  Her feet hit the floor, and she went tumbling overboard. "Uh!"  Her body was going upward now, picking herself up.  She was glad to be off the bed, at least.  This was progress. She wasn't hurt at all!

Quickly, she picked herself up and started running.  Ahh!  But she was still awkward and didn't quite catch all her balance first, so she fell again.  She had been in forward motion, and her body lost control and pitched forward.  "BOOM!" 

"Uh!"  She was sprawled out with her hands before her, elbows down.  She struggled a bit.  "Uh!" Wiggling this way and that, she grunted as she lifted herself again, until at last, she was on her yellow padded feet. WHEW!

"Mama!  Where?"  Her eyes searched left and right, right and left as she made her way out of the sun-soaked room.  Into the hallway she went, scrunching her eyes to adjust to the dark hallway. She looked under the bookcase.  She peered under the chair.  She searched.  She pouted.  Nothing was there.

Then she had a thought.  "Outside!"

She toddled over to the back door, hands smearing another set of handprints on the glass window. "Oh boy!" She smiled. Relief! Bliss!  Now she could play! 

Image 2. Her Two Kittens in a Bucket. Her eyes widened as she saw them together.  She thought they were little people stuck inside of a cat's body. One was Fluffy, and one was Mattie.  Today she would put them in her duckie bucket, then put them on her slide.  They would slide down the slide, and she would laugh the day away! Awe! She would do this over and over again, just like yesterday.

Her laughter and giggles would fill the air, just like her naturally curly hair that turned from brown to blonde in the smiles of the sunlight. Just then, her little hands picked up one furry friend, and then the other, as if they were her babies. Real ones. They jumped and played, they got belligerent and tried to run away; they behaved, and then they misbehaved. And she loved the unexpected playfulness they had, and she pretended to scold them when actually, actually, she wasn't mad at all. For some reason, she just liked to point her finger at their faces, and lecture them here and there. It just felt right. She was the teacher, and they were talking in class. Or they were in church, and one must be quiet for Mass. Humph.Yup. 

She loved to curl them up to her cheeks, feeling her soft fur on their skin. It was as if the textures mixed into one, life breathing newness into the waking world. They re-animated her 'space' like foreigners from another land, and they counted on her for food, water, and poo-poo sand! She watched them lap up their meals after playing in the hot sun, and never understood why they didn't like to join her in the blow-up swimming pool. She thought they should want to cool down; she just never understood! But there was one thing that she certainly knew...

There was nothing else that she wanted to do.

That's all she wanted; that's what the whole day just was. Playing with her babies, taking care of her babies, laughing with them and laughing at them! Keeping them 'in control' was quite the job! After swimming pool time, she was ready for a great nap. No complaining, no resistance, no whining, no saying, "No!" like a two-year old. She was pleasantly pooped, and beginning to get cold. So she was tucked in for a nap, together with her cats, and slept until dinner was ready for munch.

That's it.

So simple it was, for her furry friends to be her companions in real life. She loved every moment of being with them. She never thought about growing up. Not once. She never thought that today and tomorrow would fade away. No.  She just did the things she liked, the things that she was used to doing ~ being a mommy, feeding her babies, and playing with them. She didn't even have to work very hard at getting them to behave. They were just so naturally cute and cuddly!

And after dinner, she would brush her teeth and go to bed. 
And when she woke up in the morning, her first thought would be that of her babies. She would nurture them, spend time with them, talk to them, love them, and make sure that they knew of her love.

Each morning, this was her routine: she balanced 'just so' on the edge of the bed, and let gravity pull her down with no dread. 

Eventually, her feet touched the floor. 

And tomorrow she would be back to do it much more!

~ ~ ~ ~ ~ 

The End

~ ~ ~ ~ ~ 

You're Invited 

Join Dr Margaret Aranda's 

Memoir Madness: Ages 1 - 31 

November 1, 2016

See www.drmargaretaranda.wordpress.com for Blog-Hop-Tweet Rules

Located on the Bottom of each Memoir Madness page.

Thank you!

Follow Dr Aranda on Twitter

@DrMargaretAranda

For 

"Blog-Hop-Tweet"

Dr Aranda is Tweeting Out her Writings:

Memoir Madness Ages 1 - 31

So keep reading daily through the month of October

Follow Dr Aranda for the month of October, then Join her "Blog-Hop-Tweet!:"

Age 1

©️ Aranda MD Enterprises. All rights reserved. No part of this article can be reproduced without express permission of the author. Medical Disclaimer: Nothing is meant to be medical advice, treatment or cure. See you doctor for complaints, please.

Thank you for reading Dr Aranda's writings.

Age 1: A Baby in the Sky for Father's Day

 / by Dr. Margaret Aranda / 

It was my Father. I knew him. I had no fear.

My Father held me, the scent of cologne feeling permeating my brain such that I can still close my eyes and smell it.  There. I can do it now.  

I know he is gone, but it's almost like  he is just next door,  always there. His arms were strong, his hands with long gentle fingers that played "Two Guitars" on the piano. Get it? 2 guitars playing on one piano? That was the feeling sense of humor. "If it makes you smile," he said, "it was still a good joke."

Summertime offers beamed into my  grandma's from San Antonio family. The smell  of coffee  and bacon emanated in my nose,  and the electric percolator gurgled and puckered its  congenial hellos to my ears. My big family  crammed into the room, that  hummed with conversation here, there giggles and shouts and squeals of joy peppered here and there.  

Nutty children were just being children, running about,  boisterously  slamming the doors just as all kids do.  I still remember  who was there, it is because I  looked down on everyone. 

I could sit up straight, and my curly light  brown hair was tossed all about in freedom. I did not care  about  anything except my Father. He announced, "Watch!" while my Mother  was  simply horrified. I was mortified! My Dad told all to relax. She just stared at us.  I did not care.  

      I just could not wait! I closed my eyes and imagined little I could fly! And then ... slowly .... it StartEd ....

                  Image 1 Up! Up! Up!   I tried with all of my might to hold still. I was a frozen smile. 

                                                  Now, I was sitting in my Father's hand.

Slowly, ever so deliberately and, as I was sitting on the edge of my Father's hand, he lifted me up. He lifted me up! and Up! and Up! and UPPP! We went straight up to the ceiling, his hand and I in perfect unison and symphonic harmony. I closed my eyes for this style dance, and held in the mightiest burst of exclamations, just as tight as I could. Up! Up! I went again, dreaming of everything and dreaming of nothing. I was On The Edge, suspended. At his command, I Reached up to the eyes of a magician's audience, and slowly, deliberately touched .... I .... I ... I touched the ceiling! Those moments in time, I learned everything I needed to know about life and love. Everything.     

That was where I was going to stay. I had no fear.  

My Father would hold on to me,  just like always.  

I could do this. Together with him, I knew we could do it .  

Slowly, I beg to fly by as I held out both arms for balance. 

My arms remained still as a rock, but in my imagination, I was a bird! High ... above the clouds! 

I straightened my back. I held my breath, and wonderfully magnificently.

My heartbeat pulsated, rocking Rapidly upon my neck.

The security and the freedom, the dichotomy of the safety and the danger, they were entranced my mind to no end.

My Father had me.  

He was my Father.  

I knew it was him, and ...

I had no fear.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 

             

 ~ For Father's Day and for Always, I love you, Daddy!

          ..... Thank you for giving me the wings to  just dare 

                                                                 You are always with me and in my essence. 

                                                                                  For always and forever.

                                                                                             I love you.

Twitter: @medibasket 

The Protection of a Man

 / By Dr. Margaret Aranda

Just a simple rule in life that we need to tell our children. 

Because I have heard too many stories.

We should each strive to be positive and loving at all times. 

~ Let us Shine! ~

Invisible Illnesses: ME/CFS and "Systemic Exertion Intolerance Disease"

#DrMargaretAranda / In dedication to Luminescentfeeling Across the Pond and Still Oh! So Fond! 

Is Myalgic Encephalomyopathy / Chronic Fatigue Syndrome (ME / CFS) a "real" illness? For decades, doctors questioned its existence (See Image 1).

Image 1. The Full Circle of Redefinition. After years of neglect and stigma, we now have come full circle. Some professionals still use "ME / CFS" as a specific term, with a newer term, "SEIDOR" it is being used more generally to include other Diseases such as Lyme's disease  (CFS = chronic fatigue syndrome, ME = myalgic encephalopathy; SEIDOR = exertion intolerance systemic disease). 

The Harm.  Today, some doctors say:

• "I do not Believe in it." 
• ... I have not even "heard of it." 
• Think, "If I have not heard of it, than it must not exist . Therefore, the you are faking it. You are malingering."    
• "You need a psychiatrist."

... And do not feel alone. Millions of additional Hasta with other "Invisible illnesses" hear the same words. 

That's the shriek, shock and shame of some of today's health care.  Imagine yourself going to the Emergency. Envision the doctors en masse that repeatedly apply this phrase we all grow to hate (ie, patients with an Invisible Illness): "it's all in your head " (See Image 2).

Image 2. "It's All in Your Head." But now, guess what, Mrs. Gomez? And guess what you'll be glad to hear, Mr. Lee? It's not  'all in your head.' Luminescentfeeling  was right all along. Image Courtesy Google Search. 

The Diagnosis.  Sure patients present with elusive SYMPTOMS such as fatigue, sleeplessness, "brain fog," dysfunction of the autonomic nervous system, pain and other neurologic signs. These gleefully rampage the human body without warning or token, in a vibrant trading life for one with virtually no quality of life to be found. Now, that is not elusive to the patient. T he human mind is traumatized not only by the illness, but by the manner of disrespect and lack of compassion that is repeatedly inflicted by the medical field ... and than another trigger occurs in an instant, sending shivers and shakes of Post-Traumatic stress Disorder (PTSD), shattering through the mind and body as yet another Emergency Room doctor stares blankly at the patient, assessing that surely she is inordinately insane.     

After a February 10, 2015 multi-institutional effort was convened, the world did not know (and still does not) that 'ME / CFS' was to be  rocked to the core by multiple 'Big Boys' of the Institute of Medicine (IOM ). They were mandated to meet, confer, conclude, and advise on the answers to solve the problems of ME / CFS - after reviewing 65 years of CFS research described in over 9,000 scientific literature Manuscripts. Wow, right?   

- What did this grand Report show?   

• "Between 836 000 and 2.5 million Americans ..." have it
• About 250,000 were Diagnosed with it Britians
• Sigma is attached to the disease

Words of the NIH Director Francis S. Collins, MD, PhD:

"Of the many mysterious human illnesses that science has yet to unravel, ME / CFS has proven to be one of the most challenging"

• Symptoms "... made worse by exertion of any sort " 
• Publication of a 20-page Clinician's Guide
• A new diagnostic algorithm
• A new list of diagnostic criteria
• A Power-Point slide compendium for doctors to use for awareness and knowledge
• The dedication of Increased funding to research into this disease process

The Future.  For example, Stanford Medicine (my alma mater for anesthesiology and critical care, so okay, I may not be strictly objective here) has instituted the Stanford Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME / CSF) Initiative  as a multi-disciplinary effort of grand proportions. Their focus is on leadership, research, and education. Specifically:

"Our primary aim is to study the roles that infection and the immune response play in the Symptoms of Patients suffering from chronic, unexplained Diseases."  (Author's emphasis). See Image 3.     

Stanford's Initiative offers worldwide opportunities.  For patients who live in the San Francisco Bay area, one can  participate in clinical research . Worthwhile reads are both the Stanford ME / CFS Initiative Newsletter  and an incredibly exhaustive list of Patient Resources and information for ME / CFS here.  

Image 3 Stanford University's ME / CFS Initiative: Explaining Invisible illnesses as Infectious Diseases.  Work done by other scientists Frissora and Koch (2) and Chia and Chia (3) have tied stomach enterovirus infection to Celiac disease and Resulting CFS. Lerner et al ( 4) also showed improved outcome in Patients with CFS and individual AntiVirus Biomarkers like herpesvirus who were treated with antivirus medications. (CFS = chronic fatigue syndrome, ME = myalgic encephalomyelitis.)

"The power of the bugs remains to be fully seen."  Dr. Margaret Aranda

And where does all of this leave us now? With hope.  The hope is that ME / CFS can achieve a respectable place in physician and community acceptance, as a valid disease without the stigma of mental distress and / PTSD. And the real hope ? it is always for a cure. Read more about this with Joseph Montoya  who describes the hopeful promises that could lie ahead. 

Have hope. Do not let anyone ever take that away from you.  They do not even ... know who 'you' are.

Dr Margaret Aranda

And anyway, you live in the body. Only you know what it feels like (Image 4).

Image 4. The Power of the #rebelpatient (TM) . The patient can not be treated by a physician who never heard of the "Invisible Illness." She is Empowered to become the Stanford Medicine-X e-Patient . See #medx. 

~~~~~~~~~~~~~~~~~~~~~

* The Autonomic Nervous System (ANS)  controls all of one's Vital Signs: temperature, blood pressure, heart rate, and all the 'automatic' things one does not control such as standing up without fainting, eating food that goes through your stomach, holding urine in the the bladder without spilling it out at will, erecting the penis, holding stool in the rectum, sweating, breathing properly and more. Dysfunction of the ANS, also known as dysautonomia, is associated with syncope or fainting when standing upright.

I believe that Infectious Diseases have a more primary role in causing or worsening invisible illnesses. Since about 80% of our immunity, protection against bacteria and viruses, is located in the gut, I've been a proponent of #Immunonutrition.

We must view each bite of food as either killing or protecting us. 

Let's keep an open mind and continue to saturate our senses with good sense.

Thank you for reading my writings. 

Previously this article was printed on the infant, my Public Profile 
July 10, 2016

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

References Cited in Stanford, Image 2.

1    Hickie et al., Post-infective and chronic fatigue Syndromes precipitated by viral and non-viral Pathogens: prospective cohort study.  BMJ. 2006 Sep 16; 333 (7568): 575. Epub 2006 Sep 1. 

2   Frissora CL  Koch KL . Symptom overlap and comorbidiy of irritable bowel syndrome with other conditions.  Curr Gastroenterol Rep. 2005 Aug; 7 (4): 264-71.

3   Chia JK ,  Chia MONTH . Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach.  J Clin Pathol. 2008 Jan; 61 (1): 43-8. Epub 2007 Sep 13.

4   Lerner AM, et al. Herpesvirus Subset-directed antiviral treatment of 142 patients with chronic fatigue syndrome.  Virus Adaptation and Treatment. May 2010: 2 47-57

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Copyright ©  2016, Aranda MD Enterprises. All rights reserved. Not meant as medical advice, treatment or cure. See your health care provider to get individual treatment. 

Stanford's Sean Mackey, MD, PhD, on "What is Pain?"

 / by Dr Margaret Aranda /


 Sean Mackey, MD, PhD gives a nice, concise definition of "Pain."

It is so nice to have #BackPainDay2016 and #StanfordPain and a LIVE Stream on 9/11.
Here's the link, to be aired from 10 am to 4 pm: stan.md/1Wb4cLS


And Thank You, #SeanMackeyMDPhD and #StanfordHealth

Smell Your Breath

 / by Dr Margaret Aranda /



 Yup. Smell your breath. Is it bad? That could be due to boiled eggs, garlic, onions or peridontitis. What is peridontitis?


Well, anytime you see a word with the ending or suffix "-itis," that means there's "inflammation" that could be deadly. The original medical derivation is from the Hebrew or Greek, who coined this medical condition, peridontitis.



Medical Conditions with a Word ending in "-itis:"

• Appendicitis - inflammation of the appendix. This can lead to phlegmon, abscess, diffuse peritonitis, gangrene or death. The Clinical Diagnosis may be made by ultrasound or CT
• Ulcerative Colitis - inflammation of the large intestine leading to ulcers, pus, mucous and diarrhea. Treatment options may include participation in an Inflammatory Bowel Disease (IBD) Management Program like that offered at Stanford Health Care IBD Program
• Retinitis pigmentosa - night blindness
• Glossitis -  swelling of the tongue (see Image 1)

Image 1. Glossitis is swelling of the tongue. What is the most common cause of tongue swelling? It is dentures. Does it hurt? The patient's Chief Complaint is tongue soreness. A common medical condition associated with this 'beefy' tongue is Vitamin 12 deficiency. Medical students will enjoy the clinical aspects here, Image Courtesy:  #StanfordMedicine25.

So Let's Talk about Peridontal Disease

Peridontitis is inflammation of the gum area around the teeth, the peridontis. A quick look at the American Academy of Peridontology article entitled, "How to Keep a Healthy Smile for Life" states this:

"What you may not realize is that oral health is not just important for maintaining a nice-looking smile and being able to eat corn on the cob."

Image 2. Quality of Life is a Part of Good Oral Health. A smile is important for giving a great First Impression. It also makes us feel happy inside. People with bad teeth don't usually smile brightly because they are embarrassed by their teeth. Fully 25% of people over age 65 have lost their teeth and put dentures in bubbly stuff every night when they sleep. While this generation looses all their teeth less so than previously, the medical profession is still weighing in to wrap their arms around all the bad diseases that lead to death and can be caused by "bad teeth."




Risks and Complications of Peridontitis in Older Adults:

• Gingivitis - swelling of the gums that can lead to peridontitis and loss of gum attachment, peridontal disease 
• Peridontitis - inflammation of the gum, leading to receeding gums and exposed teeth bases; this leads to tooth and jaw bone loss
• Heart disease - The Number One killer in the world
• Atherosclerosis - hardening of the arteries
• Decreased QoL - unable to actually smile
• Forgetfulness - may inhibit a good preventive dental schedule
• Stroke, or Cerebral Vascular Accident (CVA)
• Diabetes - usually associated with chronic metabolic syndrome and heart disease
• Dry mouth - decreased saliva as a lubricant disrupts the protective barrier to gums:teeth
• Arthritis - may have adverse effects onQoL, hindering: "Activities of Daily Living, Mobility, and Instrumental Activities" (i.e., brushing the teeth) as described in the historic 1983 article by Sidney Katz, MD (1924 - May 4, 2012) in the Journal of the American Geriatrics Society
• Cigarette smoking - toxic chemicals affect more than tooth color: QoL without a smile
• Financial Considerations - reduced income from any source may put dental care to the side
• Medications - may cause decreased saliva, due to unpredictable anticholinergic side effects
• Treatment for decreased saliva - mouth swishes, sugarless gum and even artificial saliva
• Postmenopausal women - increased risk of tooth decay and gum disease due to estrogen deficiency
• Postmenopausal women and osteoporosis - osteoporosis eats away at the bones and probably the teeth, too. Further research may show that taking Hormone Replacement Therapy (HRT) decreases gum and tooth disease

Dental Replacements

• Need - do we really need all the extreme dental work that is being given in America? I think it's time to increase our knowledge, given the voracity of dental hygiene 'un-knowledge.' I mean seriously, who talks about this topic? Doctors? I don't think doctors talk about nutrition or dental care nearly as much as they need to, given the debilitating chronic illnesses we suffer.
• Questioning the System -  For culture change purposes, I'm going to be radical here. Why? Because age management principles teach doctors to guide patients in nutrition, exercise and diet so they are predisposed to less risk of getting heart disease, diabetes, and a stroke. All at once. Every day, someone is going to the Emergency Room to discover, "WoW. I had a heart attack. And I'm diabetic and I didn't even know it." That's not acceptable in American medicine. We're just better at Preventive Medicine and obviously we are still falling short. To change this scenario now, you have to question not only every morsel you put in your mouth: you need to question how meticulous you are with your dental hygiene and gum care.
• Notes on Peridontitis - it's more common in patients with heart disease, diabetes and obesity. What the 'circle dynamics' show is that this is a vicious circle. You can stop it by paying attention to nutrition and meticulous dental care.

"I just don't want you to have a heart attack with bacteria in your teeth that goes up to your brain and throughout your entire body." -Dr Margaret Aranda

• Dentures -  they are less common in the aging population than in previous decades. The denture-wearing group requires high self-maintenance and not all the aging can do ADLs
• Dental Implants - don't need to use healthy, neighboring gums support a new implant. An implant is an artificial root to the tooth; it holds an artificial tooth or bridge in a way that leaves them synchronized with the gums and jaw bones. It feels more like a real tooth
• Facial Structure - loss of teeth leaves the jaw muscles and skin many changes in structure that add to aging and adversely affect nutrition, especially in our elders

In the coming weeks, I'll be taking a closer look at common dental practices, with a specific slant: the effects on patients with an Invisible Illness. Because there's just so much more to know. In the meantime, please increase vigilance to keep your mouth free from being a bacteria-Festival.

I mean, care for your mouth even moreso now. 

Try to clean up shop if you could and just see how you can build on improvements.

 - talk to your doctor and dentist about meticulous dental care. 

~ ~ ~ ~ ~ ~ 

Dr Margaret Aranda is a Stanford alumni of anesthesiology and critical care. She and her beautiful daughter were in a tragic 2006 car accident that left Dr Aranda with dysautonomia, vertebral artery dissection, and traumatic brain injury. 🎀Her daughter is just fine. Dr Margaret Aranda is a Public Figure in Patient Advocacy for Invisible Illnesses, Teens and Ethics.

These are her Books - Genre

No More Tears: A Physician Turned Patient Inspires Recovery - Memoir

Stepping from the Edge - Christian Living

Little Missy Two-Shoes Likes a Ladybug - Children's

Little Missy Two-Shoes Likes to Go to School - Children's 

Archives of the Vagina: A Journey through Time - Girl's and Women's Health