The Year of Mind, Body, and… Wallet

Without really meaning to, I’ve decided to try to make this a year (or more) of mind, body, and wallet. Meaning that during the same time frame I’ve somehow decided to 1) focus more fully on fitness, 2) read at least 10-20 books of “literature” for 2022, and 3) limit my spending.

The fitness backstory: 2021 was a year of surprise medical problems. From the months of March to May in 2021, during what I felt was a giant positive upswing in my fitness journey (I was looking fit, toned, and strong; I was using my Olympic weight set), I started bleeding. Like, a lot. I was hemorrhaging. I had to go to the Emergency Room twice because the first time, I’d lost a quarter of my blood volume and the second time, I was well on my way to losing half my blood. Both ended up in hospital stays. I got put on different medicines to try to stop the bleeding. They never worked completely. In May, I underwent a hysterectomy and everything that was wrong in that part of my body was taken out. And after I healed (3 whole months for full healing), I had to deal with weakened muscles that ended up in back pain for which I went to physical therapy. After a few more months, I finally felt ready to start my fitness journey over. But during these months, I had gotten out of shape and weak. I wanted to be strong again. I really started rock climbing regularly and did some light weights to start, but it was in December that I felt strong enough to really take my 20- and 30-pound dumbbells seriously. So for 2022 I decided to finish what I’d started 1.5 years ago.

Reading: 2021 was also a year of loss. Like I mentioned before, I inherited a few old books from someone who was gone too soon due to Covid and never visiting the doctor, like, ever. Reading Ulysses (I’m now halfway through it) has ignited within me a desire to read more literary fodder, as in anything that’s not a “quick airport book from a tiny newsstand.” The types of books that you don’t have to think about. I do enjoy the relaxed non-heavy read. But, it’s not like I’ve never read anything substantial. I went through a beatnik phase and a William Faulkner phase. I had a Tom Robbins phase. I took Philosophy classes in college (which forced me to read Plato, Aristotle, Hume, etc.) and I read stuff like Bertrand Russell for fun. My high school had me read a lot of classics because it was 3 years of Honors English and 1 of AP English. But there were still books that were out of my reach or kind of slippery because I was simply too ADD to focus on them. But now I’m 2 decades older, my ADD is controlled, and I have the time and the life knowledge to tackle books I’ve missed. Which books? Well, I’m not sure yet. There are lists of books all over the place. My first thought is to balance the reading so that I’m not reading War and Peace and Anna Karenina at the same time, that there is a difference in time, place, author, and culture. I’d also like to read across genres and points of view. Variety is the spice of life, they say.

So far this year I’ve finished Circe by Madeline Miller and Klara and the Sun by Kazuo Ishiguro. (One of those was deeper than the other.) I’ve got Invisible Cities by Italo Calvino*, All Systems Red by Martha Wells*, Dune, and Rebecca by Daphne du Maurier* on rotation. And of course, Ulysses. From the library I have one Neal Stephenson book, Fall, or Dodge in Hell. On my “next” list is A Portrait of the Artist as a Young Man, The Three Body Problem by Cixin Liu*, and Tropic of Cancer by Henry Miller. On my bookshelf are Infinite Jest by David Foster Wallace, Gravity’s Rainbow by Thomas Pynchon, and the writings of H. P. Lovecraft. There are even more books in my Kindle and on my ebook “to read” list. My intention is to pick books that can make me pause and think, but sometimes, I’m not sure every book I pick will do that. Circe was a lot simpler read than I had thought; it was good but not as dense as I thought it would be. (I’d recommend Galatea by Madeline Miller as a more thoughtful read). In any case, I’m sure I’ll write about the things I read.

The wallet: Suddenly one day I pondered if I could do an entire year of “no spending”. This was after the splurging I did in November and December to set up my workstation at home with 2 4k monitors and a docking station. I also bought a bookshelf. Not to mention everyone’s holiday gifts. Then one day after Christmas, it hit me that I could try to do a “no spend” month where I didn’t buy anything on impulse or that I didn’t really need. I wondered how much money I could save. I thought about what were “approved” spends and “bad” spends — and if you’ve never thought of this before, it is an enlightening exercise. For people doing this, the first thing they must do is to make lists of what’s a “need” versus a “want”, what’s okay to spend on, and what isn’t. (One can look up “no spend year” and find a million links and social media about the topic.) I read this Forbes article to start.

What’s nice about the No Spending thing is that it’s personalized, for the most part. I, for instance, do not need the latest game console or video game, because nothing I do depends on that. Someone else might. Someone else might not need shampoo and conditioner, but I do, or else my hair turns into a giant, out-of-control tumbleweed. I can broadly put down in the “approved” list things like medical bills, medicines, things for health maintenance, insurance, and things for health improvements. Other “approved” spending includes food (nothing carb-loaded or deep fried), gifts (dollar limits depending on what the gift is for), car maintenance, house maintenance, vacation, and replacements for things I already own if they are used up or worn down, like soap. It’s easy to write “No late-night Amazon browsing” and remember it, hence, cutting out the possibility of ordering something half-asleep. Also, it’s easy to remember “no more clothes” and “no impulse buying”. This past week, this “resolution” has reared up at Target, Best Buy, and the grocery store, successfully convincing me to not buy something just for the sake of buying it. It was both difficult and empowering. Once January is over, I’ll try February. I’m hoping that eventually, this will turn into a habit and my wallet will be happier for it.

*Books that are ebook or library loans will have priority.

Project N95

How do you know that the N95 you bought off the internet an actual N95 mask? How would you know if it’s fake? Well, here is a website that can tell you. According to its website, Project N95:

…is committed to approving suppliers that can supply quality products. We follow a multi-step process that focuses on verifying suppliers and vetting the products offered….

Project N95

A False Choice Between Individual Freedom and Public Health

I’ve been thinking about the issue of “Individual Freedom” and “Public Health” lately, in light of dozens of news articles, Facebook rants, face-palm anti-vaxxer deaths, vaccine mandates, and me being a nurse who believes in individual freedom but have a huge science background. Are there any law-based article discussing the intersection of individual freedom and public health?

Well, Google scrounged up this article called “Individual Freedom or Public Health? A False Choice in the Covid Era.” It makes a good point: every argument, decision, rant, etc. has been falsedly based on one (individual freedom) or the other (public health). Our communities, politicians, and talking heads have set up this dichotomy and most of us have fallen head first into it and taken sides. They have set up this dichotomy in that we lose whether we choose one or the other. Instead, they could have set it up so that it’s a win-win situation.

For the real sacrifice involved in social distancing and stay-at-home orders is not individual freedom. It is the reality that these measures can cause more hardship for some people than others. For some, that hardship may be lost income; for others it may be the inability to visit their parents in a long-term care facility; for still others, it may be domestic violence…

…we should be providing people with the economic and social supports they need to maintain physical distancing. The problem is that these supports are the very things that many politicians are loathe to provide…

It is not authoritarian to demand that people maintain physical distance to save lives. It is authoritarian to demand it without giving diverse people the means to do it.

-Jonathan Cohen, “Individual Freedom or Public Health? A False Choice in the Covid Era

Can you be re-infected with the novel coronavirus? A case study.

“An 82-year-old male with a history of advanced Parkinson’s disease, insulin-dependent diabetes, chronic kidney disease, and hypertension presented to the emergency department (ED) in early-April 2020 with one week of fever and shortness of breath. He was hemodynamically stable, but tachypneic, hypoxic to 89% on six liters of oxygen via nasal cannula, and febrile to 100.4 °F. Chest x-ray revealed peripheral and basilar patchy opacities concerning for COVID-19 (Fig. 1A). His respiratory status declined in the ED, and he was intubated for hypoxemic respiratory failure and admitted to the intensive care unit (ICU). An RT-PCR for SARS-CoV-2 sent from the ED resulted as positive. He remained intubated in the ICU for 28 days at which point he was successfully extubated and transferred to the medicine floor. He demonstrated clinical and radiographical improvement (Fig. 1B), and in early May 2020 two subsequent RT-PCRs for SARS-CoV-2 sent 24 h apart resulted as negative. On hospital day 39, he was discharged to a rehabilitation facility breathing comfortably on room air.

Ten days post-discharge (48 days after first presentation), he re-presented to the ED with fever and hypoxia. On arrival he was tachypneic, hypotensive to 70/40 mmHg, and tachycardic to 110 beats/min, with a temperature of 99.9 °F and oxygen saturations of 83% on room air which improved to 96% on eight liters via Oxymizer®. Chest x-ray (Fig. 2A) and computed tomography (CT) scan (Fig. 2B) demonstrated bilateral ground glass opacities again concerning for COVID-19, as well as unilateral focal consolidations concerning for bacterial pneumonia. RT-PCR for SARS-CoV-2 sent from the ED again resulted as positive.”

Was this reinfection? Alternate considerations include the patient shedding virus for a longer period or inaccurate testing.

Genetic material from viruses can stay in a host longer even after live virus has been cleared and after symptoms have resolved. Also, how much virus is shed can depend on how sick the patient was.

According to the article, testing can be inaccurate and imprecise, with test sensitivities of 66% to 80%, depending on what instrument is used. Some tests are sensitive to “multiple different gene targets, some of which are very specific to SARS-CoV-2 infection, and some of which are quite sensitive to detection but may be common among many or all SARS-like coronaviruses.”

However, for this case study, “For our patient, while his RT-PCR on re-presentation was in fact positive, the cycle threshold required for detection was relatively high suggesting a low viral load. This could be explained by either prolonged low-level viral shedding, or inadequacy of the submitted sample. Additionally, at the time of representation and repeat positive testing, further assessment of his results revealed that while the gene assessed which was very sensitive for infection but common among all SARS-coronaviruses was detected, the gene assessed which was specific to SARS-CoV-2 was not identified.”

In conclusion, “There is large variability between instruments used for SARS-CoV-2 RT-PCR testing, and many of these results are largely open to interpretation. As in our case, interpreting cycle thresholds and understanding more about the targets of a particular instrument used for SARS-CoV-2 RT-PCR can be crucial for clinicians assessing for the possibility of true reinfection in their patients.”

Duggan NM, Ludy SM, Shannon BC, Reisner AT, Wilcox SR. A case report of possible novel coronavirus 2019 reinfection [published online ahead of print, 2020 Jul 4]. Am J Emerg Med. 2020;S0735-6757(20)30583-0. doi:10.1016/j.ajem.2020.06.079

Prone positioning

“In the setting of critical COVID-19 illness, SARS-CoV-2 infection often results in severe pneumonia and hypoxemia with many patients developing acute respiratory distress syndrome (ARDS)… Several interventions for ARDS have been evaluated over the last two decades. In particular, prone positioning is one of few therapeutic interventions for patients with severe ARDS that has demonstrated improved oxygenation and a survival benefit. Awake prone positioning outside of the intensive care unit (ICU) is safe and may decrease respiratory rate and improve oxygenation with early application potentially delaying need for intubation in patients with COVID-19… In the ICU setting, prone positioning of patients receiving non-invasive ventilation or high-flow nasal canula, with or without sedation, may also be beneficial. Physiologically, prone positioning may improve matching of ventilation and perfusion, but studies have not linked physiologic changes to clinical outcomes, especially in COVID-19.”

–Shelhamer M, Wesson PD, Solari IL, et al. Prone positioning in moderate to severe acute respiratory distress syndrome due to COVID-19: A cohort study and analysis of physiology. Preprint. Res Sq. 2020; Published 2020 Aug 17. doi:10.21203/