long-covid

What is long COVID and do you have it?

by General
long-covid

What is long COVID and do you have it?

Around 10% of people have a slow recovery from COVID-19 infection that lasts longer than 3 weeks (UK COVID symptom study). Most people will recover within 12 weeks. People who do not recover within this time-frame may have Long COVID if their symptoms are not explained by another illness.

The likelihood of developing long COVID is not linked to any particular symptoms, the severity of the initial illness or if hospital admission was needed. The symptoms of long COVID can affect any part of your body and can change over time.

What causes long COVID?

The short answer is that we do not know what causes long COVID to occur. We do know that similar symptoms have been found in patients suffering from other coronaviruses such as SARS and MERS.

There are likely to be a number of causes of long COVID rather than just one in particular. These include a persistently high viral load, inflammatory or immune reactions, physical weakness and psychological factors such as PTSD.

For people who continue to suffer symptoms, the NHS has a great website to advise on symptom management.

What are the symptoms of long COVID?

General non-specific symptoms

  • Tiredness
  • Fever
  • Pain

Fatigue

Tiredness can occur after any severe infection as the body recovers. For example post-viral fatigue is fairly common.

The tiredness in long COVID can be severe and be similar to that in Chronic Fatigue Syndrome and ME (Myalgic Encephalitis).

Psychological symptoms

  • Anxiety
  • Low mood
  • Depression
  • Poor sleep
  • PTSD occurs in a minority of people, often healthcare workers.

Persistent chest symptoms

  • Persistent cough
  • Breathlessness

Blood clots

Having a COVID-19 infection increases the risk of blood clots. This might present with breathing difficulties, chest pain, or palpitations.

Heart symptoms

20% of people admitted with COVID-19 have obvious heart involvement, but probably a greater proportion have undetected heart involvement. Symptoms include:

  • Chest tightness
  • Chest pain
  • Palpitations

Neurological symptoms

  • Brain fog, loss of concentration
  • Headache
  • Sleep disturbance
  • Pins and needles in arms or legs
  • Dizziness
  • Stroke
  • Seizures
  • Encephalitis
  • Cranial nerve neuropathy

Older people

  • Loss of muscle mass and weakness
  • Reduced appetite and malnutrition
  • Depression
  • Delirium
  • Chronic pain

Other symptoms

  • Musculoskeletal: joint and muscle pain
  • Gastrointestinal: abdominal pain, nausea, diarrhoea
  • ENT: tinnitus, earache, sore throat, dizziness, loss of taste/smell
  • Skin rashes

Which symptoms need urgent attention?

You should seek urgent medical attention if they have the following symptoms:

  • shortness of breath
  • chest pain
  • severe psychological distress or ideas of self-harm
  • severely ill child

What should you do if you suspect you have long COVID?

You should seek medical advice and discuss the nature of your symptoms with the doctor. The first thing of course is that you should have a history of having COVID-19 infection, or have had symptoms that were suspicious of a COVID-19 infection.

Long COVID is a diagnosis of exclusion. That means that other serious medical problems should be excluded before assuming that the cause is long COVID.

A relevant examination should be done according to the symptoms and may include the pulse, blood pressure and oxygen levels. Tests may also be useful to make a diagnosis and can include blood and urine tests, chest x-ray and ECG.

Take home message

Symptoms of long COVID can affect virtually any part of the body or more than one body part at a time. The condition my fluctuate and last for long periods of time.

We are just beginning to see these cases for the first time and therefore have limited experience of what treatments might work. Most of the evidence currently comes from consensus of medical professionals or individual cases that they have seen.

Long COVID is a diagnosis of exclusion so other medical problems need to searched for. You should not automatically assume that your symptoms are due to long COVID as they may be due to another problem. That is why it is important to discuss the problem with an experienced medical professional and why a number of tests may have to be done to arrive at a diagnosis.

Vitamin D container

Does vitamin D protect against COVID-19?

by General

Does vitamin D protect against COVID-19?

Social media currently abounds with ‘useful’ information about medication and supplements that will protect you against COVID-19. Much of this is hearsay and downright wishful thinking. Prime example is President Trump taking hydroxychloroquine as preventative medicine. I hope he does not come into any mischief as have so many in recent studies.

How about vitamin D?

Interest in vitamin D is has been sparked via two main channels. First of all, people are now looking with interest at a meta-analysis (good quality evidence) published in the British Medical Journal in 2017. This included 25 studies with a total of over 11,000 participants. It showed that vitamin D supplements were safe and that they protected against respiratory infections. COVID-19 causes respiratory symptoms and hence the increased interest in this study nowadays.

The second observation is that people from black, Asian, and minority ethnic (BAME) backgrounds have a greater rate of COVID-19 infection and death rate compared to white Caucasians. People from ethnic backgrounds represent 14% of the UK population but 34% of COVID-19 patients. Death rate in British Black Africans and British Pakistanis is 2.5 times that of the white population. If we look at NHS staff, then those from BAME backgrounds represent 64% of deaths despite only making up 20% of the NHS workforce. Among doctors, the death rate in Blacks and Asians is an astounding 94% of the total number.

These inequalities in COVID-19 infection and death rate have been thought to be due to greater health problems in ethnic minorities. There is also an increased incidence of poverty, and they tend to live in larger, extended families. However, that does not entirely explain the disparity in rates of death among doctors. This is why vitamin D levels have become so interesting.

Researchers from the United States have found that patients from countries with high death rates such as Italy, Spain and the UK, had lower vitamin D levels than those not so severely affected. Another study also showed that average vitamin D levels in countries were strongly related to COVID-19 cases and death rate.

What does NICE say?

As always the National Institute of Health and Clinical Excellence prefers to side with hard evidence. In December 2020 they came out with rapid guidance advising people in the UK to continue to supplement with vitamin D in the Autumn and Winter months. However, they also said that there was not currently enough evidence to support taking vitamin D solely for the prevention and treatment of COVID-19.

The problem with this guidance is that we do not have the luxury of waiting until all the evidence is collected. People continue to suffer severe COVID-19 infections, become hospitalised, die or have prolonged suffering from long-COVID. We should be acting on the evidence we have so far even if it is not the gold standard randomised controlled trials. Vitamin D is cheap, has no adverse effects in standard doses and is good for bone health. There is little or no harm from taking it and potentially great benefit.

What’s the verdict?

My opinion is that we should all be taking vitamin D supplements based on the evidence we have so far. This is especially important for high risk groups such as those with BAME backgrounds and key workers. Standard doses for adults of 1000 IU are available over the counter, and higher doses of 4000 IU are available online. Since I have multiple risk factors for severe COVID-19 including being a doctor with an Asian background, I am taking the higher dose of 4000 IU per day.

Taking vitamin D supplements does NOT mean that we should avoid taking the COVID-19 vaccine. We should also continue to follow standard advice regarding hand hygiene, face coverings and social distancing,

The results of further studies on COVID-19 and the role of vitamin D should be released later this year. These should make matters clearer once and for all. Until then, I would err on the side of caution and take supplements.

demo-attachment-502-obstetrician-at-work-PNT4KUF

How to check your health

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-183-male-nurse-with-stethoscope-MBQ4P3Y

Take care of yourself

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-346-Mask-3Group-59

How to do a body surgery

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-1334-Medical-doctor

Meet our nurses

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-492-Mask-G2roup-58

Checking your blood pressure

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-720-Mask-1Group-57-1

How to make a checkup appointment

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-719-Mask-Gro1up-55-2

How to Choose the Doctor in Massage

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.

demo-attachment-718-Mask-G2roup-56-1

Taylor Life in Other Word

by GeneralGeneral

When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us, as it floats around us in an eternity of bliss; and then, my friend, when darkness overspreads my eyes, and heaven and earth seem to dwell in my soul and absorb its power, like the form of a beloved mistress, then I often think with longing, Oh, would I could describe these conceptions, could impress upon paper all that is living so full and warm within me, that it might be the mirror of my soul, as my soul is the mirror of the infinite God! O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now. When, while the lovely valley teems with vapor around me, and the meridian sun strikes the upper surface of the impenetrable foliage of my trees, and but a few stray gleams steal into the inner sanctuary, I throw myself down among the tall grass by the trickling stream; and, as I lie close to the earth, a thousand unknown plants are noticed by me: when I hear the buzz of the little world among the stalks, and grow familiar with the countless indescribable forms of the insects and flies, then I feel the presence of the Almighty, who formed us in his own image, and the breath of that universal love which bears and sustains us. O my friend — but it is too much for my strength — I sink under the weight of the splendor of these visions! A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents.