Catch 22

Sometimes you need to do "C" before you can do "B" and subsequently move on to doing "C".  This is called a "Catch 22". 

Patty was on the breathing machine again for just a couple of days before the doctors thought she was ready to breathe on her own again.  So, I believe it was the night before last that they took out the breathing tube again.  

The last previous attempt was stopped short when it was apparent that breathing without the mechanical assistance was requiring too much effort on her part.  Her trachea and vocal cords had become swollen, as can often happen with an extended use of the breathing tube in a patient's throat.  This had made it more difficult to breathe, and she had become fatigued trying.  Also there were some digestive difficulties. 

The complicating issue seems to be phegm, and lots of it, that is congesting her breathing passages.  I asked what means their approach had to get rid of it, and was told that the bronchiodilator medicine and the use of suction to physically remove the phlegm were their means.  I noted that evidently the medicine was not enough, as the phlegm has not lessened.  It was a case of "lost in translation" again: they said it was enough, because she was getting the maximum dosage.  I said, well, apparently that isn't enough. We could probably have repeated this exchange many times, but sometimes I know when to stop trying to make a point.

With the help of a Chinese doctor friend in California, I've made an herbal formula that addresses her issues very specifically.  That's one of the advantages of Chinese medicine: formulas can be  tailored very specifically to individual cases.  The formula should be very helpful in clearing the phlegm, and as well as addressing a couple related things.  The doctors have been sympathetic and have allowed it to be administered.  However, given the digestive difficulties that have not been resolved, they are reluctant to do that now. And the number of times I've been able to give it have been few and far between.

I guess it's more complex than I'm putting it.   There is a possibility, because of the phlegm, that anything intended to go into her stomach will go into her air passages, particularly if the quantity is more than about 10 ml.

So, here it is, the Catch 22:   I have a formula that is very good for getting rid of phlegm.  But we need to wait until there is less phlegm to use it. 

Lak seems to have good faith in the Western medical approach that they are using.  I have less.  I know it can and does do amazing things.  But I know it has limitations, and I'm aware of some ways that Chinese medicine, in particular Chinese diagnosis and Chinese herbalism, fills some important gaps in what Western medicine can do.  But, before we can do B, we need to accomplish C. 

Anyway, it's frustrating. 

I am starting to write what's happening with our daughter, Patty, here on Blogger, and hope that those who want to follow her progress can subscribe.  If you do, you'll get email notices of new posts, and it will save me remembering all the friends who I want to keep posted. 

Yesterday was an upswing for her, as her breathing had improved to the point that the doctors felt it was time to remove the tube that had been supplying her oxygen-rich air from a rather high-tech "ventilator" machine.  The amount of assistance from the machine had been gradually decreased over the preceding few days, and she was showing more signs of being capable of breathing on her own.  So, yesterday she began doing all the work of breathing again.  We could see it was not easy for her, though this same process had happened several weeks earlier, and the re-entry to breathing did seem somewhat easier this time.

But when we came to the hospital this morning to visit her, we learned that she'd become fatigued, because of a swollen trachea.  So the tube had been re-inserted into her mouth down into her trachea, and she is now getting assistance from the ventilator again. 

It was disappointing to see this.  But, she obviously was not ready yet for the transition off the machine.  She still has a lot of mucous secretion in her lungs, and that makes breathing all the more difficult. 

I was able to begin giving a Chinese herbal formula for pneumonia yesterday.  I have confidence in this as an adjunctive therapy to the antibiotic approach, and hope it can be continued.  With the herbs, perhaps the mucous, which has been so tenacious, can be cleared more, before taking her off the machine again. 

So..... here is praying for the best for our much loved little girl! 

May she, and all children, all grown people, all beings everywhere, be happy, peaceful, and free from suffering.

SOM TOM   --- aka Papaya Puk Puk

Ask Thai people what their favorite foods are, and here in northeast Thailand, you will most likely get one of two answers: somtom, or pat grapow.   AND, if it's not very spicy, it is probably mai arroy (not delicious), or arroy nit noi, (not very delicious),  or "so-so".  

Somtom, or papaya puk puk (raw papaya salad, in English terms), is a very popular dish everywhere in Thailand and in neighboring Laos.  They also eat it in neighboring Myanmar.  There are many varieties of this dish: somtom Thai and somtom Lao being two distinct and popular varieties.  

Somtom sua (somtom with noodles)

One of the distinguishing differences between somtom Thai and somtom Lao is the fish sauce that is used.  In somtom Thai, traditional fish sauce is used, pretty much the same stuff you could buy in most Asian markets in America.  But to make somtom Lao, a fermented fish sauce is used that makes the taste very different.  Nam palaa, or fermented fish sauce, is probably unique to Thai Issan (northeast Thailand) and Lao cuisine, and is a good quantum leap different in taste and smell from traditional Thai fish sauce, or nam plaa. (note the addition of one "a" in Thai Issan fish sauce, nam palaa.)  That one little "a" is all the difference between tasting perhaps a little foreign (nam plaa) and tasting foreign to the degree of being strange, and definitely an acquired taste--- or not acquired! (nam palaa-- fermented fish sauce.)

Nam palaa is perhaps a staple here in Thai Issan country.  The main highway going through Khon Kaen, a "hub" city here in northeast Thailand, is well sprinkled, if not soaked, with this smelly liquid, making the road perhaps easy to identify in the dark.  Trucks carrying "pips" of the liquid (about a five-gallon can, open on top, with a plastic bag inside holding the contents) regularly travel this highway, and at any significant bump, or at any traffic light where trucks need to slow down or stop, some of that precious cargo spills out, never to be forgotten by the olfactory senses of anyone with even an impaired sense of smell that comes along the road by way of motorcycle, or any vehicle exposed that doesn't insulate passengers from the atmosphere. 
Another even more interesting ingredient is the inclusion of boo kem, or boo na.  "Boo" is crab, and boo na is a crab (or crabs) from the rice fields.  Boo na can be used fresh, and cooked to include in papaya puk puk.  Or, the boo na can be pickled in salt (scarcely any brine-- a rather dry pickling process, evidently).  This leaves the crab edible, from what I have only SEEN, but also having a smell as equally foreign as nam palaa.  The smell I can attest to.

Boo Na: rice field crabs

Boo Kem: pickled field crabs

There are many variations of somtom, and a somtom shop probably sells other "som", such as som guay, which is made with green bananas, and unripe, and ----- I'll eventually think of the name and fill it in here! and somtang, which is made with cucumbers.  While these exotic ingredients may be interesting, and tasty to the right people, I have my own recipe for somtom farang (farang means foreigner). 

Making puk puk in a large ceramic krok, with wooden saak, and a plastic spoon for mixing.  The sound of the saak banging softy against the krok is what gives somtom it's nickname for the Thas, which might be somewhat for the benefit of us farangs: papaya "puk-puk"!

To be continued next time with a somtom recipe for farangs that I think we farangs will like.

cloudy and cooler

The cool season seems to be really here now, with temperatures finally reaching my comfort zone-- most of the time -- between 20 and 29 degrees C.  Well, here's a weather site:  http://weather.thaivisa.com/khon-kaen/

The sun is still very powerful here, and a cool morning can easily give way to a hot afternoon.  But today, the clouds have stayed around, and it is a pleasant afternoon following a morning that was still easily tolerable in a T-shirt-- for me, that is.  At the morning market, some had on their winter coats, jackets, sweatshirts, and some even what I'd call light parkas.  It is a bit of sweet revenge seeing Thais shivering when I am finally comfortable.  :)  

Well, we will see what tomorrow brings.  See you then?

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