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Medical Preparedness

Day 627 and First Responder

My hands are stained blood red. Despite a good scrubbing, my cuticles definitely show that I spent time packing wounds today. Ok, fake wounds. And it’s fake blood. I am taking a wilderness medical incident certification course. And it is very hands on. Literally.

A firefighter packing compressed gauze into a femoral artery simulator

I got the opportunity to take a spot in a course that one of my friends teaches. I’ve got so much exposure to medicine after the last several years of health challenges that I’ve been yearning to upgrade my knowledge to something more practical than my own personal biohacking. So when Tom offered up a spot in his medical incident certification course for wilderness response, I said you know what fuck it I’m going to do it.

And I’m so glad I did. Not because I anticipate needing to apply a tourniquet in the back country of Montana. Or that I’ll be faced with packing a groin wound to stop someone from bleeding out when they are hours away from the hospital. Though I am glad I now know how. But because I think hands on experience with a rougher world is experience I need to do my job investing in an increasingly complex, chaotic and unstable world.

I was absolutely enthralled by the first day. It was me and a bunch of other much more experienced EMTs, paramedics and wildfire fighters. I also met a number of extremely savvy folks who special in fire and emergency incident response.

I was very much thrown into the deep end of first responder world and I’m not ashamed to say I “died” on the very first scenario test as I’ve got no idea what I’m doing. But I’m soaking up as much information as I can as fast as I can. Though not quite as fast as arterial blood gushes. Yet. Ask me on Friday if I’ve improved.

I couldn’t tell you precisely why I think this kind of hands on exposure to emergency response is so crucial but something deep in my gut says that I cannot possibly invest in a changing world without having some on the ground exposure.

The folks who are fighting our worst wildfires and responding to our most intense natural disasters know something visceral about chaos and the fragility of modernity that the rest of us do a lot to suppress.

Just casual conversations as we went through lessons and practice opened up my mind to new areas of opportunity. I found half a dozen blind spots I didn’t know I had. The world is much more chaotic than the media and our social channels let on. But it’s also possible to tackle them head on. We are not helpless. And it’s not hopeless. And I’m feeling fully empowered to deepen my relationship to chaos as I learn just when and where I have more agency.

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Preparedness

Day 626 and Learning

I’ve been slowly making my way through a Korean show on Netflix called Extraordinary Attorney Woo. It’s about a young woman with autism who has a gift for the law. It’s warm hearted and charming and a bit of a relief to watch if you have autism or are on the spectrum. I highly recommend it.

The show really pulls on my heartstrings. The episode I am currently watching features the struggles of 10 and 11 year old kids who are at after school academic centers. I won’t ruin the plot but a young man sets out to “liberate” the kids by letting them play. I found myself tearing up the show went about discussing the need for healthy playtime.

I hated going to school even though I love learning. I found so much of the pressures of school upsetting. Being inside, being around lots of people and loud noises, and just generally being obligated to things like homework and deadlines to be exhausting and anxiety inducing. I found myself tearing up watching these Korean kids in similar situations.

I was quite lucky to have a mother who sent me to Waldorf schools and even the occasional home school year. When I could pace myself I’d would rapidly out run the curriculum. I just needed breaks and playtime and my own opportunities to self direct. I hated discipline from the outside but had plenty of my own if given the chance to be self directed.

I’m still an autodidactic type as an adult. This week I am taking a wilderness medical incident certification course. I’ve got some strong sense that this is meant to wrap around some wider learning experience about the practicalities of living in a more chaotic world. It’s a bit of learning by doing. Some perspectives have to be unraveled first hand.

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Chronic Disease

Day 621 and Pain’s Anxiety

Before I was diagnosed with my spinal condition ankylosing spondylitis, I didn’t really understand that I was in pain. I know that sounds weird, but I just knows I felt like shit. I hadn’t yet pinpoint the origins of the crisis in my own body. I was a stranger to myself.

Back then getting a diagnosis involved a lot of questions about my mental health. Are you anxious? Would you consider taking an anxiety medication just to see if it help? Are you sure it’s not all in your head? No doctor I’m not sure of anything that’s why I’m asking you.

The thing is I did feel anxious. My central nervous system was in a perpetual state of fight or flight from the pain. I had tachycardia. I was twitchy. I wasn’t a sleeping well. I didn’t want to be touched. It hurt too much. I was exhausted all the time and felt overwhelmed that no one seemed to know what was wrong with me. I’m lucky no one asked me if I was depressed or I might have been put on Prozac.

I’m one of the lucky ones. My chronic disease has a simple blood panel and physical exam to diagnose it. It only took me a few specialists to get to a rheumatologist.

I fear I would have been given an anxiety diagnosis and told it was all in my head if I’d had something more complex. But thankfully we untangled that any anxiety or depression I felt was simply a function of being in an inflammatory condition so acute every movement was painful. You’d have a racing heart and a fear of movement or touch too if everything was painful to the touch

The thing is I am scared of my pain. I do regularly get caught in fight or flight fear responses if the pain appears and I’m not prepared for it. I am militant about certain aspects of self care and my biohacking as I fear flares. I fear the drugs that are required when it isn’t controlled. It makes me anxious to need drugs at all to control my symptoms. Especially in America where a war on drugs has made it hard to need anything stronger than Advil.

Everything about pain and it’s treatment is anxiety inducing in America. And that’s a hard comorbidity to live with in a disease. As if pain wasn’t enough, the latent fear that you might not be believed lingers.

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Preparedness

Day 620 and AQI

I am in the throes of a horrifying migraine. The take two Imitrax and pray type. It’s also the nausea inducing type so I’ve not eaten all day. I feel awful. And it’s mostly not my own fault even though I often like to blame flares in symptoms on my own lack of discipline or purity in maintaining some Platonic ideal of lifestyle or wellness regimen.

It is fire season in the west and I’m sure some, if not most, of my migraine is tied to the horrifying air quality that is choking out thousands of miles of California, Washington, Oregon, Idaho and Montana.

An AQI reading of western America on September 12th at 3:48pm Mountain Time from PurpleAir

The AQI or air quality index in my neck of the woods is 160. Unhealthy for sensitive individuals is the coy and somewhat misleading phrase used. It means in practical terms visibility is so bad I can’t see the mountains a few miles away.

Montana is at the moment free of any major fires. Our colder temperatures, lack of pervasive fire beetle blight, and reduced density makes it statistically safer than the Colorado front range when it comes to total fire danger. But it’s no safer from prevailing winds and the pollution from fire in other states. In order to escape from it entirely I’d probably have to leave the continent.

I’ve obviously opted not to leave my home region of the mountain west even if I have accepted moving to a more northern and protected corner of it. But there is a certain existential “No Exit” sense I have with AQI and fire season in general. It may just be my lot in life. Maybe it’s everyone’s lot. To give up your homeland is a complicated fight. I expect for some of humanity it must involve either certain death or the prospect of great riches

Categories
Aesthetics

Day 619 and Indoor Clothes

I have one issue on which I am a little obsessive compulsive. I hate when someone wears dirty clothes on a clean bed. It just drives me absolutely up the wall.

I suspect this is born of some totally rational preferences. I am very outdoorsy and always have been. As a child I spent as much time as I could negotiate at the barn. I worked as a stable hand as part of keeping my own horse’s board and feed paid. If you’ve ever kept animals or worked on a farm you know how barn clothes smell at the end of a long day. You don’t wear your barn clothes except when you are choring. It’s rude.

Then when I left Colorado for New York City I found another reason that your work clothes should be taken off at the door. Instead of smelling like manure, urine and stale sweat after a long day mucking stales you’d smell like shit, piss, the subway and traffic exhaust. City smells are no more polite to bring inside than barn smells. Getting splashed by a cab or sitting too close to someone who hasn’t showered in a while on the subway is just normal life in a city.

You can probably imagine now a routine in which I take off my outdoor clothes and swap them for my clean indoor clothing. I try to do this as fast as is possible. I can’t fully relax unless I know I’m in my indoor clothing. Because unless I’m clean I cannot get into bed. And there can be no dirty clothes on clean beds.

I simply will not let myself even get on top of the comforter of my bed with outdoor clothing on. If I want to get under the covers and fully relax at home, I better be in clean designated “indoor clothing.”

It still upsets my brain when I see a teenager on television lounging on their bed with shoes and jeans on. Maybe suburban sitcoms neighborhood are a cleaner environment than the one I grew up in?

Or when an adult couple is about to get it on and then tumble into bed with their coats and jackets and high heels. I just hate that. I shudder. I don’t want to bring dirt and shit into my love making. Sorry it’s just my preference no shame if that’s your kink. But absolutely not in my house.

I’ve finally fully trained my husband on this quirk. He keeps a clean set of pajamas to change into and is careful to keep barn clothes to the barn. As for me, I like this quirk. I keep a cleaner house because of it. Sure it’s a little weird but I love a nice clean safe place.

Categories
Chronic Disease Politics

Day 618 and Personal Politics

I hesitate to share too much detail about this but, I’m an opioid user.

Actually I’m not hesitant to share that at all, it’s in fact the core salient point I want to make today. I have a chronic disease and sometimes, blessedly more and more infrequently, it can only be effectively treated with pain medication.

Why am I talking about this? And in public no less? Because unless powerful people that have a degree of social, personal and political capital discuss things we deem unsavory we never make any damn progress on humanizing our inhumane responses. And our response to the opioid epidemic is inhumane.

The backlash to the crisis, a mash up of intense scrutiny, government intervention and rigid rules, has now reached a point where it is doing as much harm as the original crisis of overprescribing. And I hope my personal story allows you to see why.

My spinal condition (ankylosing spondylitis) can be so debilitating that the only way I can get out of bed to accomplish basic tasks is by taking a mild opioid called Tramadol. It’s not in the same category as OxyContin or Percocet but it’s not risk free either.

I’m lucky that my condition is relatively well controlled. I don’t need pain medicine all the time and I work very hard on alternative treatments in the hopes that I won’t need it at all in the future. I spent a small fortune making sure I don’t need a core useful medicine. Let that sink in.

I’m not an addict. I am monitored by a team of professionals. Every step of the way is in fact monitored extensively by state and federal systems along with massive insurance and hospital system oversight. It’s the closest I’ve come to experiencing the Panopticon. It’s life altering in its scope. My entire life by necessity has to revolve around when the system deems it safe for me to get a prescription. Not when my doctor thinks I need it. When Uncle Sam does.

I fucking hate relying on something so dangerous and so demonized but also so regulated. I hate that my entire private medical life is so closely monitored by the state. I hate all of it. But, on very bad days, the choice is immobilization or Tramadol. And I’m not at all ashamed to say I pick Tramadol. I want to be a working productive member of society and that’s hard to do when you are unable to move from the pain.

There is no grace in suffering but what it teaches us. And I’ve learned we use pain as a cudgel to control people in our society. That it is so effective is why I am both a libertarian and fiercely against the carceral state. One day it might be you suffering and you won’t deserve it either. And I pray that you will be shown grace in your personal circumstances.

But I’m lucky. I’ve got other pharmaceuticals, like biologic injections which treat inflammatory conditions, that I can rely on. I’ve got THC and CBD for their anti-inflammatory properties. I’ve got good old fashioned steroids like Prednisone. Which interestingly, my physicians universally believe is more dangerous than my Tramadol usage and did actually require an extended titration down as I was physically dependent on it, as your body stops producing the necessary hormones. They’d rather I use Tramadol for flares.

But you notice the government isn’t up in your face with a massive publicity campaign showing cops busting down Prednisone rings. There are no political advertisements showing how an opponent supports big steroid. Even though if you saw Donald Trump after he got Dexamethasone during his fight with Covid it was pretty clear he felt pretty good. Steroids have gotten me far more fucked up and also higher than any opioid ever has. But no massive surveillance program has ever come down on anyone for anti-inflammatory drugs.

Because that would be fucking ridiculous even though it’s just as addictive in driving physical dependencies , just as debilitating and depending on your body chemistry, just as “fun” as narcotics. Fun fact about me, I don’t have whatever chemical makeup that allows an opioid to give me a high. Which as I’ve learned is a saving grace. Not everyone does. That’s kind of the rub. The risk profile on opioids is a bit worse because some pharmaceutical executives lied about the percentages of people who get addicted. Or who found it’s side effects pleasurable in the absence of symptoms. They did not lie about the benefit of not being in pain.

And that ought to give you a good sense of the problem at hand. The iron law of prohibition strikes again. A massive bureaucracy imposing a fix that intervened in crude and inflexible ways is causing more suffering than it fixes. It wasn’t the intent but it is the outcome.

The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases. Cowan put it this way: “the harder the enforcement, the harder the drugs.”

Because doctors were lied to about the risk profile of certain types of opioids in the first place, the backlash is now as bad as the original sin the pharmaceutical companies committed.

Regular law abiding people are getting fucked in their treatment plans because hard enforcement is making it harder to get the low dose drugs. We treat Tramadol users with arthritis with the same tools as as criminals addicted to illegal fentanyl. I know shocker that the American federal government can be as evil as Purdue.

But also historically you know it’s true. And now a huge portion of normal people like me, who just want the benefits of not being in constant pain, are being turned into an over surveilled over controlled population. And I’m not saying there are no risks. But who do you want deciding that? A doctor who knows you well? Or the government? Yeah I’d pick the doctor too.

Categories
Emotional Work Preparedness

Day 613 and Timing

It’s hard to look straight on at your desires. Why is it that some of your life arises from your priorities and focus, but others are just chances and circumstances?

The hardest part about looking face first at being responsible for yourself is that you are both in total control and not in any control. We want to live with willpower. We want to be people of purpose. And yet life is happy to show us how much it’s all just dumb fucking luck.

Because we are what we make time for in our lives. And if we don’t make honest time for ourselves how the fuck will we ever know what we actually want. If you let life idle past you that’s fine. Because that is the path of fulfillment all along. And in letting ourselves just be maybe we find entirely new reservoirs of resources.

I’m considering taking a wilderness first responder course. I’ve got other priorities for the fall but I also made a commitment to a resilient rural life. Somewhere in my own desires I may find that what I want can and does align with the rest of my life. That by opening up to something new I also see who I am more clearly. I believe they call it getting perspective.

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Preparedness

Day 612 and Errands in the Apocalypse

A lot of preppers have fantasies about how they will come into their power with the fall of civilization. Their foresight will show them to be the stoic masculine leaders society always needed but were wrongly maligned in the feminized world of diversity capitalism. Needless to say I think this is quite silly even without the sexism and racism.

Total collapse scenarios are not your most likely outcome. Sure we all think about what it might be like. A safe society enjoys horror stories. Chances are much better you will experience a couple issues compounding on each other. A few cascade are enough inconvenience such that it fucks up your life, but not so much that your boss doesn’t expect you to go to work in the morning. And definitely not one where law and order breaks down so far that you can get away with shooting someone. The police can’t help you but in anarcho-tyranny they sure can hurt you.

My first taste of this was during Hurricane Sandy. Lower Manhattan lost power for close to 10 days. Gasoline shortages and food access became issues as some neighborhoods were in the dark. But enough of the city was fine, and enough institutions in dark zones like Goldman Sachs and the NYSE, had their own backup systems.

You as an individual might be fucked but the institutions expected your ass to show up for work. I had a girlfriend who had to walk from Greenpoint to Madison Avenue for a social media job. Can’t imagine anything more dystopian than having your corporate Twitter shitposting job require you to have a butt in a chair when your own home is without electricity and molding. Cyberpunk is here.

Today in Montana our air quality is an abysmal AQI of 120. Wildfires blowing in from western fires in Oregon have tinged the sky yellow. Apparently it’s worse in Missoula with a number sky of particulates trapped in the valley.

But it’s Sunday so I had errands to run. We were coming off having a houseguest with us so we needed to grocery shop. We had a prescription that needed picking up from the pharmacy. We live outside of town so we try to plan a bunch of stores per trip. It felt like the end times outside. You couldn’t see to the mountains. Visibility was limited. But damn it we’ve got work next week and the meal planning is done so we’ve got to keep going. Life finds a way. There will still be errands during the apocalypse so don’t get too hopeful about your cosplay.

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Preparedness

Day 605 and Inventory

I like to be prepared. It’s my personal opinion that this winter is going to be a bit rough. There is no single issue but rather a patchwork of intersecting crisis points that make me a little edgy.

You’ve got crop yields all over the place from another wild climate change year. You’ve got the rising costs of fertilizers. You’ve got an energy crisis brought on by the war Russia is waging against Ukraine. You’ve got whatever China is up to with its Covid policies. And then of course you’ve got our lingering economic fuckery and well you can see why I’m worried.

I went through our emergency food stores today and did some turnover and replenishment. We didn’t opt to move some things with us to Montana (some items had expiration dates necessitating donation) so it’s been on my to do list.

I’ve got a spreadsheet that includes fats, starches, sweeteners and less glamorous proteins like beans and canned fish. It theoretically calculates our our caloric needs and what is provided for in our supplies so we can more easily assess if we have enough on hand for different scenarios. In reality, I’ve never actually had full inputs clean enough to generate an output I trust. So I kind of wing it with this basic level of precision.

I’ve tried to abide by basic best practices for emergencies. Ready.gov is a surprisingly decent resource even if it might shock you what you should have in hand. You need supplies for a three day disaster like a snowstorm or hurricane. You need three weeks of supplies for an interruption that takes a bit of resolve. And you ideally three months of food on hand if something goes really wrong. The Mormon Church says you should keep a year of food on hand.

I don’t think we’ve quite got a year of food on hand but I have taken a lot of tips from the LDS suggestions for food storage. We’ve got pounds of wheat (and a hand crank grinder). We’ve got 25lbs sacks of rice. We’ve got big jugs of cooking oils. We’ve got sugars. We’ve got spices. I’ve got quite the collection of dried legumes.

I feel like I basically have what is necessary for a bad winter in Montana. I hope we’ve got enough for any supply chain constraints that might make it harder to get things to our modestly more rural homestead. But in truth I’m just following lists and hoping if something happens I didn’t fuck up too badly. And I’d we did well we’ve got shotguns and ammunition and the local deer are a little too cavalier about their safety. For now.

Categories
Emotional Work

Day 589 and Mental Health

Trigger warning: discussing depression and oblique references to suicidal depression. If you are in crisis please call 988.

I had a scare this morning. Someone I love is going through some stuff. I didn’t know if they were safe for a short period and I found myself frightened by the prospect of losing them.

When I learned they were safe I was relieved but also angry because how dare they scare all of us like that? I scrambled to cope with my own feelings and a desire to engage in codependent behaviors. I called my therapist and pulled myself together.

While I don’t suffer from depression it’s not an entirely foreign concept to me. It has felt closer over the pandemic as I’ve seen others struggle. I have family members and friends who live with varying degrees of chronic depression and I have witnessed first hand how much strength it takes live with it. I have chronic pain and I don’t think it is even in the same ballpark of debilitating as depression.

I’m not any kind of expert and my advice is mostly me talking into the wind so please only take what serves you. But what I’ve learned is that people genuinely do care about mental health if you want to seek a connection. We want to help. We want to help those that want to help themselves. Your people do love you and you may have more of them than you realize.

Sometimes it feels impossible to ask for help. Maybe you cannot ask friends or family because of any number of reasons. But that doesn’t mean you are alone or no one is here to help. There are hotlines. There are 12 step meetings. There are apps and services. As one internet friendly to another you are not alone. If you need mental health care please take whatever step feels feasible even if it’s just a text message into the either. You can do it.