Shredding a Life

Mortality is on my mind. So is storage space in my basement. I have a 3 drawer file cabinet that is hard to stuff more into. I decided it was time to make room.

I started with old check stubs and check registers. I had saved them forever. I had tax returns starting with the first year I paid taxes. I saved that one, but the rest of the last century (and some of this one) were not necessary.

Work and school-related stuff came next. I had course notes that I’ve never looked at. In round one I saved my Anatomy and Physiology drawings because they were the first evidence that I could draw something representational. (They got tossed today.) Anybody need a bunch of 3-ring binders? I don’t plan to be working much longer so a lot of work stuff went; much of it was outdated anyway.

I found reference letters people wrote for a job I didn’t get 25+ years ago. Reading them brought a tear to my eye and made me wonder how anyone could not hire that guy. I found the Strong Interest Survey that I completed during a job search 30 years ago. It told me I had very little in common with people who chose careers in sales or the military. Was I surprised?

There is stuff from an organization I helped start nearly 50 years ago. I already lent it to them to scan on their 40th anniversary, so the original paper may not be necessary. I trimmed that file but couldn’t part with all of it.

Bonus! Shredded paper is compostable. If your compost is mostly vegetable scraps, paper adds needed carbon. Compostable materials are thought of as green (e.g. vegetable scraps) and brown (e.g. dried and shredded leaves). Most of us have too much green in our compost. Paper adds some brown.

Doing this helps me let go of my identity as a worker. I can admit that I will be retiring soon and don’t need that stuff. It helps me realize that life is unpredictable. Any of us can die at any time. None of us are getting younger, so the probability of death increases. Do I want to make my kids sort through this? Might what I choose to save have meaning to them?

On the other hand, I found my book of county road maps, useful for planning bike rides. It is old, but town roads and county highways tend not to change much. I kept it. I have route maps and cue sheets for dozens of bike rides. I didn’t try to cull those.

Since we were talking about mortality, I received an indirect death threat for a recent COVID-19 post. I had already blocked the commenter, so the comment went to my trash file, but it warned me to delete this blog “before the villagers with pitchforks and torches head towards your house.” I thought that was all I as going to say about that. I was wrong. Hang onto your hats…

Stroke Week

Since we raised the topic, let’s talk about COVID-19. Many of you read these posts before the comments appear so won’t have seen the exchange I had with the person who calls themself “covidpilot”. They referred to the vaccine as the “COVID clotshot”. Ironic, then, that my move from the ICU back to the intermediate and general care COVID units this week brought me face-to-face with a bunch of young (as in, young enough to be my children) people with strokes.

Mostly, the COVID posts herein have been to highlight the personal experience of working with the COVID-19 population. Since misinformation in the name of “following the science” has reared its ugly head here, we will delve a little more deeply into the literature. (For each journal article I have noted the source and year of publication. Full citations available on request. Since this is not a scholarly article, I don’t want to take up a lot of space with citations.)

Strokes in people that young aren’t unheard of, and the journal Stroke (2020) lists a number of risk factors for stroke in the young. Stroke occurs in about 0.01% of the population under 40 in the US (Vascular Health Risk Management, 2015). So it could be merely coincidental that I saw several young people with strokes this week, way more than I ever saw when I worked on a neurology unit regularly. But I don’t think so.

“Just the facts, ma’am”

The International Journal of Stroke (2021) published a meta-analysis of 61 studies of COVID and stroke. The articles were all before the advent of the Delta variant, which has, at least anecdotally, affected younger people more than the earlier variants. Even before the Delta variant, the meta-analysis concluded that “individuals with COVID-19 who developed stroke were significantly younger” [than non-COVID patients with stroke]. [Emphasis added] They found that “pooled results…suggest a particular profile of COVID-19-associated strokes, characterized clinically by severe NIHSS [National Institutes of Health Stroke Score] and poor outcome and radiologically by large artery occlusion and multiple arterial territory involvement. ” In plain English, COVID patients are younger and have more severe strokes than non-COVID patients. It cannot be conclusively proven, at this time, that COVID caused the strokes, but the high correlation “suggests a causal relationship.”

covidpilot referred to the vaccine as the “COVID clotshot”. A search of PubMed for data re: risk of clotting after vaccination vs after infection revealed “The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population.” [Emphasis added] (BMJ, 2020). The European Medicines Agency (referenced in Saudi Medical Journal, 2021) found “the number of observed thromboembolic events in vaccinated patients are much lower than expected as calculated in comparison to the incidence of events in general population.” [Emphasis added] In other words, while some people had strokes after the vaccine, the numbers are lower than would be expected in the general population – so the vaccine does not appear to be a factor. Taquet, et al (2021) looked at the relative risk of clot after: 1) COVID infection, 2) mRNA COVID vaccination, and 3) influenza infection. They examined over 500,000 cases and found the chances of serious clotting (they looked at CVT – cerebral venous thrombosis – as this is one of the adverse vaccine effects that has been reported anecdotally, and PVT – portal vein thrombosis) were 6.67 times greater from the disease than from the vaccine (for CVT) and 7.4 times greater from the disease than from the vaccine (for PVT). Patone, et al in Nature Medicine (2021) found: “In summary, although we find an increased risk of neurological complications in those who received COVID-19 vaccines, the risk of these complications is greater following a positive SARS-CoV-2 test.” [Emphasis added]

So yes, covidpilot is correct that there are reports of neurological and clotting complications following COVID vaccination. Most of the papers reporting those complications are case reports – reports of a single person having a complication temporally related to the vaccine. No causal relationship is demonstrated, though occasionally implied, and sometimes claimed (though more often by readers than writers). The papers claiming increased risk showed a much greater risk from the Astra-Zeneca vaccine than from the mRNA vaccines more common in the US. The papers which compare the relative risks from the vaccine vs the infection universally find that the illness carries greater risk of complication than the vaccine.

For those who missed the prior exchange, here it is:

In the news…Covid clotshot kills covid cult cardiologist who said that he would shed no tears for the selfish unvaccinated at their funerals. Poignant irony

I follow the science, not the pharma narrative. Antwerp ICU covid patients are all vaccinated.

Not sure where you’re going with this. It appears that you are calling the vaccine the “COVID clotshot”, while also claiming (in your next comment) to “follow the science”. If you can show us science that shows risk of death from the vaccine to be greater than the risk of death from the virus (even if you limit it to the relative risk of death from clotting disorders) I would be more inclined to take you seriously.

if you could show good science that the risk of death from the virus is greater than the risk of death from the clotshot, I might stop needling you. Of course, then you’d have to actually have some autopsy sampling of VAERS covid vaccine death reports by the CDC, but they don’t seem very interested in doing actual science that might question their narrative that vaccines are “safe and effective.”Hence, we don’t know much about the actual risk of clotshots. It looks like VAERS reports are the best science we have. Accordingly, we should use it.It looks like adverse event underreporting runs about 30x actual reports (1). Let’s use the CDC figure of 9,367 covid vaccine VAERS death reports. So it looks like there have been about 270,000 covid vaccine deaths, which is a small fraction of total vaccinations.As of now, the risk of death from covid is tiny for two reasons. First, it looks like we may have achieved herd immunity in the US. Second, the risk of death is small when antiviral treatment is used–20% of baseline. So my plan requires that early antiviral be given to high risk patients. Maybe 1% of the US population is actually at high risk from covid. But probably 90% of that group has some sort of immunity to covid. So we are talking 0.1% of the US population being seriously at risk. But antiviral cocktails given early–yes, I am assuming early treatment–will reduce covid mortality by 80%. So that looks like maybe 25,000 deaths from covid per year, which is in the range of flu. The clotshot so far this year has racked up 270,000 deaths, based on our estimates.It looks like continual boosters would be required if we followed your plan–with the undiminished risk for each booster–resulting in continual, straight-line vaccine deaths in all age groups.So, now, the risk from vaccination looks to be far higher than the risk from covid–especially for younger cohorts.(1)

To thecovidpilot:Your “science” is lacking. First, the VAERS system is notoriously unreliable. In their own words: “Reports may include incomplete, inaccurate, coincidental and unverified information. The number of reports alone cannot be interpreted or used to reach conclusions about the existence, severity, frequency, or rates of problems associated with vaccines.”

Second, the citation you offer does not support your conclusion of underreporting by a factor of 30, nor do the underlying articles cited in that source.

Third, even the data you cite are not specific to your assertion that the risk of death from clotting disorder is greater from the vaccine than from the disease.

Fourth, correlation does not equal causation. In randomized, double-blind, placebo-controlled trials, adverse reactions to the placebo are reported routinely.

Fifth, the article you cite is from before the COVID vaccine. There are clearly political factors at play here that were not at play during the period studied. There is a large and vocal anti-vaccine group, much more so than with any single prior vaccine. That group has a vested interest in reporting adverse effects. One could assert that there are those with an interest in falsifying reports of adverse effects for political gain. One cannot ignore that public health officials have received death threats for their work.

Sixth, as Stephen Wright told us, “42.7% of all statistics are made up on the spot.” I have seen no evidence to support your dual assertions that only 1% of the US population is at high risk and that 90% of that group has “some sort of immunity” to COVID. This leads to your next false assertion.

Seventh, you assert (due to your “calculation” above) that 0.1% of the US population is “seriously at risk” from COVID-19, though the death rate to date is already 2.5 times that.

Eighth, Johns Hopkins has confirmed 762,972 deaths from COVID-19 in the US as of 11/13/2021. They have confirmed 47,050,502 cases of COVID, for a death rate of 1.62% The reported (unconfirmed, and subject to the biases VAERS cites) deaths attributed to the vaccine total 7793, while 439,034,461 doses of the vaccine have been administered. This yields a death rate of 0.002%. Even if you limit the count to those fully vaccinated (which would eliminate anyone allegedly killed by the first dose and anyone who chose not to get the second dose due to an alleged adverse reaction to the first dose), the death rate is 0.004%. Thus the risk of dying from the virus is at least 400 times greater than that of dying from the vaccine, and probably considerably higher than that. [emphasis added]

Ninth, since this is my blog, this is the end of this discussion. If you would like to continue to spread misinformation, disinformation, or misleading conclusions from incomplete information, you are free to do so on your own site.

I left out a few points from that exchange. covidpilot asserts that we “may have achieved herd immunity”, yet still expects 25,000 deaths per year into the future. cp wrongly equates this to the number of deaths from influenza, a disease for which no one asserts we have herd immunity. covidpilot has a “plan” to give early antiviral treatment to high risk patients, though their own numbers show that all high risk patients are already dead two and a half times over.

Since the people I have seen the past two weeks have not been in cp’s “high risk” category (unless the anti-vaccine covidpilot considers unvaccinated people to be high risk) they would not qualify for cp’s early intervention. Since the set of people who oppose the vaccine and the set of people who don’t take this disease seriously appear to have a high degree of overlap, and have historically avoided presenting to hospitals until near death (or post-stroke), the proposed “early treatment” would likely not reach those people.

Nonetheless, I have decided to give covidpilot the last word. Here is their last message, the one that I blocked:

“You might want to shut down your blog before the villagers with pitchforks and torches head towards your house. People are VERY angry about all this and they are waking up.

Bicycling First Aid

  • If in doubt, go to Urgent Care
  • If anything is possibly life-threatening, call 9-1-1
  • If somewhere between those two, have someone take you to the nearest Emergency Department
  • Nothing in here is to be construed as a substitute for obtaining professional assistance
  • If your helmet strikes the pavement with your head in it, it is time for a new helmet. A bike helmet is a single-use item in that regard. Before you throw it away, crush it. (It’s not that hard, and can be satisfying in a way. Thank it for its service as you destroy it.) Destroying it ensures that some innocent person won’t come upon it in your trash and say, “Sweet! A free helmet!” and place their self at risk.
  • Road rash is your most likely ailment. That’s what your water bottle is for. Squirt the road rash liberally with clean water right away. It will hurt less then than it will later. Try to get dirt and gravel out as soon as possible. As soon as you can, wash thoroughly with soap and water. Again, the sooner you do it, the less it hurts. Bandaging road rash is tricky – you don’t want a dressing to stick to it and re-injure the area when you pull it off later – and road rash usually appears on bony prominences (joints) so it is hard to get dressings to stay in place. For road rash you want:
    Non-stick gauze
    Roller gauze
    Maybe 2×2 or 4×4 gauze pads depending on wound size and drainage
    See photos below. You may also needs gauze pads (not pictured) if particularly leaky. Hot tip: Cut tape first, stick one end where it’s handy, then you have tape ready without having to free up hands to cut it while trying to hold a dressing in place. The non-stick gauze is impregnated with petroleum jelly (Vaseline), which will make it stay in place so your hands are free. It will also make it not stick to the wound when you remove it later. And it keeps the wound bed moist to promote healing. (Sorry Ivy, who hates the word “moist” almost as much as “mouth feel”.) The roller gauze soaks up some fluids and keeps the Vaseline from attracting dust and grit in the air. The band net holds it all in place. It works well over elbows and knees, where it is hard to get dressings to stay. Cut it longer than you think you need.
  • Broken collar bones are the bane of cyclists. See a doctor for that. The treatment advice I have would make this too long and I’d rather do it face-to-face.
  • Broken ribs are likely if you are older or crash hard. Treatment is mostly pain control. In the old detective movies, the hero got kicked in the ribs, stumbled back to his office, and had his secretary wrap yards of adhesive tape around his chest. He’d head right back out to the streets and bring down the bad guy.
    Broken ribs hurt way too much for that. Plus, the old adhesive tape technique increases the risk of pneumonia. You have to breathe and the chest wall has to stay mobile. Ibuprofen is not recommended, as it slows the growth of new bone, so retards healing. Lidocaine patches can help with pain. The bad news is that they only work for 12 hours, then you need 12 hours off before they are effective again. Kinesio-tape can help with the pain and swelling from rib fractures. It can stay in place for several days.
    Apply the tape as shown. Round all corners so it is less likely to peel. Apply the tape as shown in the picture below. The two pieces should cross over the area of greatest pain. There should be no tension on the tape. Rub it to activate the adhesive (which requires mild heat). The photo below is taping over a bruise. Same concept for ribs; the central point of the lattice should be the area of greatest pain.
  • I should probably add that, if you have to provide CPR, Good Samaritan laws prevent you from being sued if you make your best effort. Get trained on CPR and use of AED. Both can be done without training – it beats watching someone die. What is written here is not training. I’m not going to fit a ½ day course into a paragraph; and I’m not qualified to train you. You can do compressions only without breathing. Check for a pulse first. Don’t do CPR on someone whose heart is beating. They won’t like it and it won’t help. CPR requires effort – deep and fast. About 2-2 ½ inches deep and 100-120 times/minute. My trainers taught me to sing “Stayin’ Alive” or “Another One Bites the Dust” to keep the tempo. For most people, the former is probably a better choice; though if I woke up to my rescuer singing the latter to me, I’d be happy. It is not comfortable for the patient. Ribs may be broken. As my friend said after he came back to life, “My chest really hurts. I think she broke my ribs. But don’t tell her anything. She saved my life and I’m not complaining.”
the legs running diagonally up and to the right are a little short…


copyright Jay Ward Productions

On another note, our Fearless Leader told us about the “beautiful” test for COVID-19. I don’t know about his definition of beauty, but that’s a mighty long swab that goes into your nostril. If your nasal passages didn’t curve, it would come out the back of your head. Luckily, it’s a very flexible swab. It tickles but it doesn’t hurt. If you need the test, get tested. If not, save the test for those who do need it, as the supply is limited despite what Fearless Leader says.

After insisting he didn’t need the test, he announced on a Friday night that he’d just been tested. I haven’t been able to determine how long it actually takes to perform the test. The CDC website is vague on this. On the day I was tested I was told it would take 4-5 days to get results. Maybe it’s faster if you’re the President. (And mine came back in 72 hours, per the original estimate.)

If that sounds like a confession, it is.

This reminds me of the HIV/AIDS crisis in San Francisco in the 1980s. Anonymous testing centers were set up throughout the city. Test results only went in your medical record if you volunteered them. Everyone wanted to be tested but no one wanted their results known. To have AIDS as a pre-existing condition meant the end of health insurance for you; not to mention the end of your love life. People didn’t want to come near you. No one would touch you. Treatment was still experimental. Life span was considered limited. When I had a mysterious illness in 1993, my doctor’s first actions were to test for HIV and TB. (I had neither – and I had been monogamous since my first negative test, when my partner insisted we be tested before having sex.)

Now (at least temporarily) insurance is not an issue. At the time I am writing this, I am in “self-quarantine”. Before you read it, my negative result will be back and I will no longer be a pariah. I came down with a cold after visiting an ill family member in Minnesota. Many of my co-workers also had colds and missed some work. That is pretty normal for this time of year. What is not normal is for me to be sick enough to miss work. That hasn’t happened in years. I’m sure my resistance was lowered by my surgery this winter. I lost my voice but didn’t really feel all that sick. I started riding the bus to work instead of riding my bike, in order to save energy, and because my dormant asthma was beginning to raise its ugly head. I was able only to whisper most of the day, which was what convinced me to stop working until I could talk again. I had to sleep sitting up. I was inhaling Albuterol in order to sleep without coughing. On Thursday I was diagnosed with an acute asthma exacerbation secondary to an acute upper respiratory infection (a cold). I was placed on a five day dose of oral prednisone and told to return to work on Saturday. I did not meet criteria for COVID-19 testing.

On Friday evening, Employee Health placed me on paid administrative leave. I was ordered to undergo COVID-19 testing and not return to work until a negative result was posted and they notified my supervisor in writing that I was cleared to return to work. I was to self-quarantine. Note that this was now two weeks after I had gotten sick and the night before I was planning to return to work. I was clearly improving, and was told I would improve greatly after the second day of steroids. They could not yet tell me when a test would be available. Note that this was days after our president claimed that the beautiful test was available to anyone who wanted it. I, as a front-line health care worker, did not yet have access to the test.

On Saturday, I was called and instructed to report for testing. I was greeted by a doctor, RN, and CNA, all dressed in disposable gowns, gloves, and masks. They all placed face shields when we entered the testing room. Swabs were inserted though my nostrils to my nasopharynx (back of the throat, farther down than you’ve ever reached, or maybe thought possible). They were held there for 10 seconds to soak up some goop. That was it. Now go home and wait. (People in Italy singing together, from their balconies, while on lockdown.)

I decided life was not surreal enough so I decided to watch The Twilight Zone. Season one, episode one was called, “Where is Everybody?” A man walks into a town with signs of recent (as in moments ago) life, but there seems to be no one around. The streets here look something like that now. It was the perfect choice.

My neighborhood library branch was to have a grand re-opening in a new location last weekend. The grand opening was canceled, but the library was to open anyway. Monday it was closed due to staffing shortages. At least I got to see the outside, complete with covered bike parking. And I got to ride my bike for the first time in 2 ½ weeks. It felt great! (And later that day they announced that all libraries were closing effective Tuesday, 3/17.)

Now I know I don’t have COVID-19. I still can’t work because I can’t talk without coughing. The prednisone has not worked its magic. I can’t tell that it did anything of benefit. I can’t very well wear a sign that says “I’m negative!” so as not to scare people when I cough. Sort of the anti-Hester Prynne. While I don’t have it, that does not put me at any less risk of getting it now. While I’m no longer quarantined, that doesn’t make life much different.

The airlines are asking for a federal bailout. The banks and investors are buoyed up by slashed interest rates. Meanwhile, all of my neighborhood restaurants are closed. Some of them allow curbside pick up, but you can’t go inside. Most of those employers don’t provide paid sick leave. Some are doing it voluntarily right now. Who is going to prop them up? They don’t have billions in reserves.

Giro d’Italia

The Giro d’Italia, previously scheduled for May, has been postponed indefinitely.

I could have sworn I had used this clip already, but the WordPress search feature didn’t find it, nor did my manual search. Adrian Monk suddenly looks positively normal. As usual, if you only read this in email, you see only my words and miss the good stuff.

As Walter Cronkite used to say: