walkitout: (Default)
I've been reading _Is it All In Your Head?_ by Suzanne O'Sullivan, MD. On the whole, it is a very good, very important book. Unfortunately, there are a few things in it that I had a problem with. All of my complaints involve when O'Sullivan steps outside her neurology arena and starts applying what she is talking about in patients she sees in her neurology practice who have symptoms (seizures, paralysis, weakness, loss of feeling, etc.) in her area of expertise which do not behave the way those symptoms should behave when objective tests are applied (EEG, electrical stimulation of nerves, reflex testing, etc.) in areas in which she has no expertise. Especially allergies and food intolerance.

Some people have meat allergy which appears for the first time in adulthood, and which in some people disappears after a few years. The onset of the allergic reaction tends to be quite delayed vs. most food allergies.


This is a _classic_ instance of "Oh that must be medically unexplained but surely can't be a REAL allergy because real allergies don't behave that way." Adult onset. Delayed. Etc. ON TOP OF THAT, it's a reaction to a _carbohydrate_, and allergies are reactions to proteins. Right. RIGHT?!? (ETA: I am describing a rhetorical position here; it is not mine.)

To be clear, O'Sullivan makes no mention of meat allergy or alpha-gal. (ETA: Technically, it is not hers, either.) I am using it as an example. We got really incontrovertible evidence of the _mechanism_ that alpha-gal delivered via tick bite causes adult meat allergy when scientists wanted to figure out why there was regional variation in negative reactions to cetuximab. (ETA: My position is the science-y one. Science has shown conclusively that at least some adult onset meat allergy which behaves very unlike some allergies is caused by a tick bite.)

O'Sullivan is ALSO very clear that every year, something with no medically known cause is found to have a medical cause. She just figures that it happens so rarely that people are really bending way too far over backward looking for medical causes and not looking for psychological causes and that needs to change. I don't actually disagree with her general thesis.

On page 190, she talks about candida and candidiasis, and that period of time now past when a lot of people thought they had it but actually didn't test positive for it even when medical professionals looked really hard. On the next page, she says:

"In the twenty-first century the exact same symptoms are more likely to be attributed to gluten sensitivity or allergies."

I'm not necessarily going to argue about the basic idea: there is a fraction of the population -- not trivial in size but not by any stretch of the imagination most people -- which will tend to latch on to the latest Oh This Is Causing All Your Problems, adopt an associated set of health prescriptions (usually diet oriented Don't Eat This / Do Eat That) and try to pester everyone they know into doing the same, while claiming that it cured all their ills. I'm not even _opposed_ to the general phenomenon. I figure each one of these things helps some subset find the thing that really was wrong with them, they stick with what worked for them, and the herd moves on to the next thing. My theory is that some day, everyone will have finally found the thing that worked for them and we'll all feel about as well as we can. (Is my progressivism / optimism showing? Oops! I'll try to cover that up again. I know it is unseemly.)

Here is what she says:

"I recently went to a dinner party where every person bar two, at a table of ten, reported that they had an intolerance of or allergy to at least one foodstuff. Most had developed the allergy in middle age, which is not how an allergy typically behaves."

She's a neurologist. How did she become so expert at allergies? Adult onset allergies are not particularly uncommon. Adult discovery of allergies is also not uncommon and sometimes deeply tragic. And every time someone decides to actually do a general population study for food allergy, we learn all kinds of new things, which means the field is by no means all caught up with reality. (See alpha gal above, but did you know that 2-3% of the general population is allergic to shellfish? I didn't. I am, and I didn't know how common it was. Legal Sea Foods has employees who have been quoted in the press saying that every little bit somebody shows up from the Midwest, eats something they've never had before and drops from anaphylaxis at the table and often is never revived. Don't you think this is something that maybe shouldn't fucking be dismissed so readily?)

I live in an area where food allergy is taken very seriously by restaurants, in part because of restauranteurs like Ming Tsai (mmmm Blue Ginger):


I've got food allergies and intolerances (yes, Dear Reader, both the proteins AND the sugars in milk cause me problems -- and not just cow's milk either, alas), some of which were detected in infancy and some of which I learned about the hard way as an adult. My husband has food intolerances. Many of my friends have food allergies and intolerances. The group that the author encountered may well have self-selected -- this was a party, I'm assuming some of these people hang out together on purpose. I know it's much easier to socialize with people who have or know someone who has food issues. Dealing with doctors like that one at T-weekend a while back -- or Dr. O'Sullivan -- is the worst. Here we've finally figured out a way to stay out of the doctor's office, and the doctor is now joining us for dinner and trying to tell us that it's just a phase.

No, dear doctors. No, it's not just a phase. It's not all in our heads. And just because food allergy now doesn't look like we used to understand it before is actually reflective of progressively better understanding of food allergy. Which it would be nice if you put some effort into catching up on.

She also disses IBS as probably psychosomatic; she seems blissfully unaware of FODMAP.

Oh, and as near as I can tell, this book is further evidence that in the UK, when people say "learning disabled", they mean something super-different than people mean in the US.

I have no reason to disregard O'Sullivan's neurology based expertise. I agree with her that there is a population over-using (to their own detriment and our shared expense) the medical system in pursuit of something which would be better found through the mental health professions. We part ways whenever she steps out of her area of expertise, which leads me to suspect she hasn't really understood the mental health side of this problem at all.
walkitout: (Default)

I generally trust Snopes. But everyone can screw up (I used to go look up entries in the Encyclopedia Britannica decades ago after reading a recent scholarly monograph on a topic, and count how many assertions in the entry were baldly untrue. It was like shooting fish in a barrel, because if I was reading a monograph, it was because I thought the conventional wisdom was dead wrong, and of course a current monograph is the best way to find out short of doing the research oneself).

In this case, Snopes is correct that Alcaligenes viscolactis does exist in some water systems, and can therefore grow in sun tea. There error lies in the assertion that Alcaligenes viscolactis is a dangerous bacteria. It is not. Cultures of it are sold for use in middle school and high school biology lab _because it is non pathogenic_.

So if you make sun tea and it turns all ropy and syrupy on you, you grew yourself a nice batch of Alcaligenes viscolactis, and it might be gross enough that you don't want to drink it. But it almost certainly won't make you sick. I can't even find instances of A. viscolactis making _immunocompromised_ people sick.

Could sun tea harbor other pathogens? Presumably. Pathogens can turn up anywhere. I mean, if you are making sun tea on a porch, a bird could come by and dump something in the sun tea and you could die of salmonella. But I don't think you need to worry about the non-boiling aspect of sun tea. You should instead focus on making sure that wild critters don't have access to the pitcher, whether you made your tea in the sun or with boiling water from the stove.

ETA: In Snopes defense, they depict sun tea being made in closed containers. So, good practice! You should do it that way, too.


The snopes comment page includes this comment. If anyone can track the incident down, I'd love to see details. The link is broken, but I'll check wayback next.


"From Colorado State U website:

"Using the natural rays of the sun to make tea is fun and popular in the summer. However, using such a method to make tea is highly discouraged. Sun tea is the perfect medium for bacteria to grow. If the sun tea has a thick or syrupy appearance, it may be due to the presence of a ropy bacteria called Alcaligenes viscolactis. Ropy bacteria are commonly found in soil and water.

Several years ago in Ohio and Washington, several people became ill after drinking tainted ice tea. In Washington it was determined that the tea had been made with tap water only heated to 130 degrees Fahrenheit and left to sit at room temperature for more than 24 hours. As a result, the Centers for Disease Control and the National Tea Association recommend the following when making tea.

* Brew tea bags at 195 degrees F for three to five minutes.
* Brew only enough tea that can be consumed within a few hours... SNIP ...

Adapted from "Bacteria-filled iced tea can cause illness," Fort Collins Coloradoan, June 12, 1996, Pat Kendall.


Here is the wayback machine version of the colorado state extension newsletter. It adds nothing useful.


The Straight Dope is _also_ a source I trust.

Wow, this is amazing!


I think I'm done for now, altho I may dig around in CDC disease outbreaks to see if I can find the original of the Ohio/Washington sickness claimed by Pat Kendall. The Fort Collins Coloradoan has archives, but not for 1996 (yet). But judging by what is showing up in derivatives, I doubt there is further detail in the original article.
walkitout: (Default)

R. showed me a short article in Spectrum, thinking that this was what I had posted about the other day. It is not. This is ultrasound. I posted about photoplethysmography, which I have probably spelled wrong this time. Not the same at all, notably in that the ultrasound version actually works.

Very exciting development! People have been fiddling around with ultrasound for BP for decades (since before the early 80s, for sure), but generally the solutions involved cuffs. This is a cuffless, non-invasive strategy and would allow measurement of the full waveform which might give us more insight into what is going on with the cardiovascular system.

Here's hoping they productive this puppy and sell it on amazon in a few years! I know I would buy one.
walkitout: (Default)
I was innocently reading my mail today when I ran across this:


There are some problems with this article. I had trouble finding a link either in this, things linked to by this to the article which found problems in the previous app, "Instant Blood Pressure", to the Johns Hopkins article describing an attempt to validate the app by people not connected to the app. So, you know, google.


App failed to detect most of the participants in the study who had high blood pressure, incorrectly saying they had normal blood pressure (using 140/90 as the cutoff, in case you were wondering).

The initial article I read had the perspective that, duh, of course this won't work, which honestly I initially did not have any problem with. But alas, as with a lot of bad rhetoric, the more the author went on, the more suspicious I became of that assumption. Helpfully, a word is supplied! photoplethysmography

Anyone who has ever been around a woman in labor, or any other poor unfortunate being continuously monitored by machines that go "beep" knows just how evil continuous blood pressure monitoring is. It disrupts focus, the ability to sleep and I still think it isn't good for the nerves distal to the cuff, I don't really care what anyone says. And can running a cuff that often be good for blood pressure walls? Can it? Really? (See what I mean about assumptions?) If you could take something along the lines of a pulse oximeter (which while obnoxious, is much more readily ignored than an automated cuff going off every fifteen minutes or whatever) and a microphone taped to your chest and use that instead, I am pretty sure we'd all just LOVE that, amirite?

But is it _real_? Sure, there are at least some scammy apps out there (surprise). And sure, there is going to come a day where we probably should actually do some enforcement on scammy apps that amount to some form of health care fraud.

But can cuffless photoplethysmography actually _work_?

It's not looking good, if people are resorting to things like this:


On the other hand, this:


I'm inclined to agree with the general thrust of this one: interesting possibilities, but not ready for clinical use yet.


I hadn't realized that people had been working on this stuff for as long as they have, nor did I know there were commercial cuffless products out there already. Also, OMG the things they do to validate _non-invasive_ systems.


I can only hope that pigtail catheter was in the aortic arch for some other reason; the idea that they put one in to do this bicycle stress test is a little horrifying.

Oh, and while I focused exclusively on the BP aspects of photoplethysmography, one or more of the apps made other claims as well. If you are wondering about the ability to detect cholesterol non-invasively, well, I haven't found anything about using a camera, microphone and computing power that will do that, but I did find this:


ETA: I did find this, which seems sketchy at best:


Also, there are people working on using impedance, which I'm pretty skeptical of. And a while back, people working trying to use IR as well. For the whole non-invasive cholesterol thing.
walkitout: (Default)
We went to the Cape for a week, Aug 20-27. I'll try to get those posts in, but that might take a little while because A. doesn't start school until Wednesday and T. not till next week. But the sitters are back at work at the schools, leaving me with Actual Responsibilities.

In the meantime, I read my email this morning, and ran into this:


While I certainly love that Dutch medical care for chronic conditions that have a crisis (say, diabetes and the possibility of amputation) lead to actual, in person conferences including the patient, patient's spouse or other family member/advocate, and involved health care professionals, we don't really do that here. We should, but we don't. The patient in the description is, basically, the person managing her care, unless she is unable to, and then someone else is responsible and if she wants to control who that is, that's what Living Will/Health Care Directives accomplish in our system.

I recall some years ago TV news coverage of a woman who called an ambulance to pick her up at the waiting room for the emergency department of a hospital. She had been there for some time, waited for hours, and was, according to the news report, suffering from an asthma attack and in need of immediate care.

While is is certainly very exciting to read about things like an asthma patient waiting for hours in the emergency department, it calls into question the meaning of a word like "asthma". Our general sense of the condition is either not critical (like the kind I, my husband and our son have), manifesting largely as a variety of terrifying sounding coughs that never actually result in breathing stopping or even being all that impaired (they didn't call it asthma when I was a kid, then they called it asthma for a while, and then they were back to not being asthma but maybe being some kind of reactive airway or who the hell knows. But if is very manageable without meds or anything else other than Don't Stop Exercising Suddenly and keep up with your allergy maintenance regime) or rapidly deteriorating. If you have the not critical kind, then calling for an ambulance to pick you up in the waiting room of the emergency department to find a more cooperative hospital no longer sounds like We Need to Fix Our Health Care System and now sounds more like, okay, who exactly is paying for this, anyway.

The story at MedPage made me think of the asthma story. So I thought about that for a while, and I thought about what I knew about POTS and I looked up Ehlers-Danlos, where I saw that it typically has minimal impact on life expectancy and yet this young woman had already died. I know, it is terrifying to see things like tachycardia and a rare medical condition one has never heard of, but lots of things (including some kinds of tachycardia and many rare medical conditions) have much, much, much scarier names than health outcomes. Also, there is a flavor of Ehlers-Danlos with no genetic test.

Then I read the MedPage piece for a third time, and I thought to myself, Self, you have read books about personality disorders. When Jess says:

"But as a human I know that "Tears = Bad" and anyone that cries for twelve hours while begging someone, anyone, to call their physician of record isn't faking it. She didn't stop crying until a doctor with some humanity sedated her following shift change. The complete disregard for her pain stripped her of her dignity and brought me to tears.""

I start immediately thinking of all kinds of stories I have read in these books about personality disorders and other mental health conditions. Jess is right: when someone cries for twelve hours, they are not "faking" it. And I don't doubt that knocking her out stopped the crying. But I also start thinking about the phrase, "personality disorder". But I was having a really hard time thinking which one. I could think of several this _could not possibly be_, and I know you've already figured it out, because the record keeping pretty much is a dead giveaway, but what I did was give up on the thinking and went back to what I do best.

I typed, no quotes: hypermobility ehlers danlos syndrome personality disorder

This is the top result:


Perhaps, some day, we will have a genetic test to explain why so many people in my extended family have agoraphobia, or something that looks sorta like it (I always think of it as Won't Leave the House Syndrome, and over time it degenerates into Won't Talk On the Phone and, in the last decade of life, Won't Actually Talk At All Syndrome). I would not be surprised one teeny tiny bit that virtually all mental health issues have at least a partial genetic/physical underpinning. Nor would I be surprised to learn that there were immune system, nervous system, autonomic system, joint system implications (the joint pain in my family alone is epic).

But until that Shining Day in the Future when All Has Been Debugged, we are stuck working with what we know. Plenty of sleep at a consistent time. Good food in the right amounts. Clean water. Appropriate physical activity. Supportive friends and family. Meaningful work. Etc. If you have a medical condition that doctors can't help you with, more time in the hospital trying to make them fix you isn't going to actually change the fact they can't help you with it. It is tragic. It is wrong. We should collectively work to fix it.

I sure felt sorry for the nurses, and I'm a little surprised that it didn't occur to Jess that maybe that "broken" call button had been intentionally disabled. I mean, it's damn easy to do (happened accidentally to A. when we were in for her appendectomy; when the bed call button didn't work, I found the staff call button on the wall and hit that. We sure got action then! And the people who showed up made for damn sure the bed alarm was hooked up after that. I, of course, apologized profusely for hitting the wrong button. "By accident." The staff call button cannot be disabled. Why Jess didn't just hammer on that puppy is beyond me. *shrug*).

Anyway. I hope to hell someone makes progress on Ehlers-Danlos. Things like this look interesting:


This description is a nearly perfect description of one of my cousins:


I'm pretty selective about how I access the medical system, but I see a lot of positives in the primary care model where a patient has a relationship with a professional who then supports access to the rest of the system. However, I have also become increasingly clear on how ill-prepared primary care physicians often are when they encounter that complex nexus of mental and physical health problems with no adequate solution within allopathy.
walkitout: (Default)
This morning, R. took A. to her 2 week follow up appointment, where the fine medical professionals that put the extremely sticky clear plastic adhesive and cotton balls on her got to be the ones to remove the extremely, you get the idea. She asked them to go slow, she tells me, and they did. Despite it being clear from her shaky tone in telling me this story, she had a smile on her face. Which is powerful evidence in support of the hypothesis that people don't get sued because of whether or not they did something incompetent or painful under the guise of Helping You -- it's whether they listened to you and incorporated your preferences where possible. (I'm not suggesting that the people being sued were not ALSO incompetent -- I'm noting that incompetence often is regarded as Excellent Care when communication and respect happens in conjunction with it.)

I'm just glad I didn't have to remove the adhesive. Because I am terrible at that and my personal preference is, as you probably expect, for fast vs. slow, which makes me the worst person to assist A. with this.

Everything looks great. I got to look at the results from pathology when R. and A. came home. Supposedly there is a picture of the appendix somewhere, possibly at the patient portal. A. and I watched a little video about the appendix in the course of me trying to figure out what some of the phrases in the path report meant. This turned out to totally gross my walking partner out, so she left in a hurry. I feel a little bad about it, mostly because it didn't even occur to me that it would be an issue.

Since the sitter wasn't due to arrive for a while, A. and I went to the bank to get me money and her a lollipop, then Roche Bros for cheese and candy. I then turned her over to the sitter; they were pretty happy because with the followup done and everything A-OK, A. can now swim! Woot!

R. headed out for a bike ride. I vacuumed my car out (I've been thinking it needed it for weeks, but it took until today for me to be bored enough to actually go do it. It looks so much better now!). I went through my sock drawer, and found a pair of child's socks that had somehow gotten lost in there, as well as numerous tall (?) socks that don't really work with my calves and honestly never will. In the course of figuring out which ones to get rid of, I realized that there are actually pairs of tall, wool socks that _work_ with my calves. Who knew? They are a different brand from the ones that don't work. I know -- in retrospect, an obvious result!

ETA: I've also been reducing the number of messages languishing in my inbox. Along the way, I ran across R.'s rec of Biffy Clyro "The Captain", based on my affection for Imagine Dragons and Maroon 5 (this rec was from slightly more than a year ago). Neither "The Captain", nor the more recent "Howl" does it for me. But, you know, I finally went and gave them a listen over on YouTube, so that's something. (That is some odd imagery in the videos.)
walkitout: (Default)
This isn't a new idea, but I'm starting to see coverage of it in new areas.


Secondary coverage of this:


This is interesting, because the secondary coverage in this case is written by one of the (many) study authors. Some of the other study authors -- ones who probably did more of the actual research work, given that their names occur later in the list and Cynicism -- produced this:


Basically, if you take opioids for some kinds of pain which involve glial cells Acting Up and Making Things Hurt That Would Normally Not Hurt, the pain will continue much longer -- even after you quit taking the opioids. Yikes! I knew about opioid induced hyperalgesia, and that was heartbreaking to learn about (truly, a Fate Worse Than Death --- you take something thinking the worst it will do is kill you, but you hurt so bad you can't stand it, and it instead makes the pain worse). Now it turns out that you can't even narcan your way out of this Fate Worse Than Death.

Good news:

"the U.S. Food and Drug Administration (FDA) has now approved two glia-targeting drugs for Phase 2 clinical trials for the treatment of neuropathic pain: ibudilast (Avigen’s AV411) and propentofylline (Solace’s SLC022). In addition, ibudilast has FDA approval for testing its ability to increase the clinical efficacy of opioids. While having distinct mechanisms of action58,59, both ibudilast and propentofylline are orally available, blood-brain barrier permeable, glial activation inhibitors (based on microglial and astrocyte activation marker suppression) that have strong support treating pain from various rodent models58,59. Ibudilast has a long history of safety in humans for the treatment of asthma and post-stroke dizziness. Propentofylline has previously been tested in humans as far as Phase 3 trials for treating Alzheimer’s disease, with the trial discontinued for lack of efficacy."

ETA: Yeah, I just noticed that too. You CAN narcan your way out of this Fate.

walkitout: (Default)

This is so cool!

"Researchers led by Mary K. Crow, MD, of the Hospital for Special Surgery in New York City have found that virus-like endogenous elements that were long ago incorporated into the genome but that have no role in encoding for proteins may have a very different role: that of erroneously upregulating interferon in certain genetically predisposed individuals, ultimately leading to disease."

So, "junk DNA" includes virus like crap.

"Throughout genomic evolution, these potentially disruptive insertions have been tightly regulated, primarily through epigenetic methylation of DNA, and alterations in methylation in the L1 promoter region could permit increased expression and immune dysfunction, according to Crow."

Epigenetic changes can turn these stretches of otherwise non-encoding DNA on, leading to overproduction of interferon and lupus and similar diseases.

"The researchers first obtained biopsy samples of kidney tissues from 24 patients with lupus nephritis, and salivary gland tissue from 31 patients with Sjögren's syndrome, another condition associated with high expression of interferon." And what they found correlated with symptoms. They "found correlations between L1 mRNA expression and interferon-α2 in lupus kidney samples as well as in Sjögren's salivary gland samples."

They caught the retro-elements being transcribed. They _found_ the promoter region that turned it on. Exposure to cigarette smoke is believed to be something that can kickstart this whole process (there are surely others).

To be clear, this is obviously super _not cool_ when it happens to someone. However, it is incredibly amazing that someone has put the whole chain together to make sense of it all. And this was research led by a woman (ha!), in the context of history in the field of a bunch of men preaching the central dogma.


Not to mention a long history of mostly men doctors telling women with these kinds of diseases that it was all in their heads.

Functionally, this is _why we need women_ in STEM.

Also, this is yet another reason why (a) smoking is not a good idea and (b) letting smokers be around anyone else is an even worse idea (and not just when they are smoking -- the stuff is breathed out of their lungs for hours after the fact).
walkitout: (Default)

I was worried about this. It was a relief to get the ruling and see that it went the way I thought it should. It is terrifying and depressing when Freedom and Liberty and Rights are eroded just because it so happens that it is a woman's Freedom, Liberty and Rights in question.

The opinions are worth a look:


A lot of the losing argument is really offensively technical, imo (res judicata). It feels like the conservative side grasped at straws through this whole process.

I look toward the future with more optimism for women having to make difficult decisions. This will be one less thing dragging them down.
walkitout: (Default)

It's a provocative headline and actually true: it does show the effect of legalization on teen use. It's just not in the direction that people who fear legalized marijuana expected.

"In 2015, 21 percent of Colorado youths had used marijuana in the past 30 days. That rate is slightly lower than the national average and down slightly from the 25 percent who used marijuana in 2009, before legalization. The survey was based on a random sample of 17,000 middle and high school students in Colorado.

"The survey shows marijuana use has not increased since legalization, with four of five high school students continuing to say they don’t use marijuana, even occasionally," the Colorado health department said in a news release."

The article makes clear that any teen who wanted marijuana before legalization in Colorado basically could get it, just like the rest of the country. The article fails to mention that now that middle-aged parents of teens are using MJ, it's Just Not As Cool any more, but I feel that has to be at least a small factor.

Years ago, on a particularly beautiful Sunday morning, I got up early and walked from my condo on Cap Hill down to Etta's in Pike Market for breakfast (my then boyfriend drove down sometime later and we drove back). I said hi to nice black families walking to church. I marveled at people walking home from whatever they'd been up to since the night before, in costume that look real different in the brilliant summer sunlight. And for several blocks, I walked alongside a guy delivering drugs -- not then legal -- on foot. Nice shoes, very, very inconspicuous and comfortable for running in clothes. He was chatty and I learned a variety of things. Like, he had regulars he made deliveries to, and one of those regulars was coming off a heroin addiction with the assistance of MJ.

I got to thinking about that after reading the Colorado article, googled and, indeed, people really do that.


I don't want to be a big ole meanie and take people's pain meds away. Really. I want to help people Not Die. And I think legalizing marijuana and treating it as a gateway OUT of more serious drug dependency (and as a way to treat the problems less effectively and more dangerously treated with opioids) may make a lot of sense.
walkitout: (Default)

As I expect nearly every reader knows, public interest in opioid abuse/overuse/overdose/death has been quite high in recent months/years. This is probably mostly because the number of people dying as a result of opioid overdose has gotten to be on a level with things like automobile related deaths. There has been a push -- at the state level, at various agency levels, etc. -- to get doctors to prescribe fewer opioids for shorter periods of time. There is a community of patients suffering from chronic pain and the doctors who serve them which has objected to this additional regulatory pressure. The article examines the problem.

"Dr. Julia H. Lindenberg, a primary care doctor at Beth Israel Deaconess Medical Center in Boston. ... But when Lindenberg’s practice stepped up urine testing, the doctors found that a few longstanding patients, who had been considered at low risk for abuse, in fact were misusing drugs. Some had cocaine or other drugs in their urine, and some were not taking the prescribed opioids, suggesting they were selling the pills."

Contrast Lindenberg's story with this primary care doctor's:

"Baratz said he, like most other primary care doctors, has long experience managing patients who take opioids for chronic pain. These people, he said, have no part in the addiction crisis. He monitors them closely and stops prescribing at the first hint of abuse."

I sort of wish the Globe had asked Baratz if his practice was also doing regular urine testing on chronic pain patients who had long-standing opioid prescriptions.

The article concludes with people making dire predictions that people unable to get legal pain meds will switch to illegal ones (indeed, some will -- that's exactly why we're trying to reduce opioid prescriptions. They have such a tendency to result in people becoming addicted and turning to illegal opioids for cost and convenience reasons) and people with chronic pain will commit suicide.

I predict we will be seeing more articles like this over the coming months. I hope more of them include details about which people being quoted are doing urine testing and which ones are not. That's a helpful detail, that lets us know who is actually committed to best practice ... and who is committed to status quo ante. Anyone committed to status quo ante who is worried about an increase in suicide has perhaps not taken seriously the increase in deaths due to opioid overdose over the last few years.

Also, if you are thinking along the lines of, those poor people, don't just take their pain medication away, I would point you at this:


In at least a few cases -- as Lindenberg pointed out -- taking away the pain medication actually helped with the pain.
walkitout: (Default)
Tigana Press -- looks like it might be the author's own; other than this book, Amazon has a book by the same author about herbal treatments from a hundred years ago for treating the flu.

This is a small pub/self pub diet thing that I stumbled across purely by accident. Apparently, it has taken Vashon Island by storm, for whatever that might be worth.

The book is written in the Quite Awful Way that most diet books are written. So I'm not even going to get into that. I'm instead going to analyze the eating pattern being promoted.

(1) It's a dietary effort to minimize metabolic issues associated with pre diabetes.

(2) Distinct meals, lots of them (3 meals and 2 snacks)

(3) anti grains and high glycemic stuff like potatoes, insists on breakfast (but breakfast is protein and fruit/veg), anti sweeteners (caloric and otherwise), volumetric, proportion rather than portion. The golden ratio for this is: 1/3 protein and/or grain, 2/3 fruit/veg (with the exception of breakfast).

(4) Timing matters: breakfast to be very soon after awakening and there's supposed to be a big gap between the last food consumed and bedtime.

There is a _significant_ inconvenience/expense factor for this eating plan: most oils, peanuts, wheat and anything like wheat, dairy, anything GMO, etc. is off for the elimination phase and only some of it comes back later. It's almost impossible to imagine eating out during the elimination phase.

Speaking of the elimination phase, in addition to trying to reduce insulin overload during the first few weeks, this diet seeks to remove some common food allergens, with a goal to determining whether that is part of why someone is having troubles. I would argue that if you completely cut milk products for a month plus, and you are middle-aged, odds are that if you weren't lactose intolerant going into this, you will be lactose intolerant coming out of it. *shrug* I don't care; I'm allergic to milk products anyway. Treating wheat and wheat like grains with comparable suspicion (down to insisting on wheat free soy or tamari sauce during the opening phase) fits well with the current anti-gluten trend. Also, dried corn, peanuts are eliminated entirely, altho part of the justification there is to get people out of food ruts and to avoid some common molds. This seems like an incredibly weak argument, imo.

So basically, this diet starts out as an allergy elimination diet, with a proportion rule, 3 meals, 2 snacks, eat breakfast upon awakening, last meal some hours before bedtime, no grazing, no sweeteners, no alcohol, don't drink your food (no juices, smoothies, etc., but soup is okay -- this aligns well with a bunch of scientific studies on how we compensate for calories consumed in a beverage vs. in soup) and no dried fruit.

Interestingly, eggs are NOT eliminated, even tho red meat is (I'm assuming this is an inflammatory thing). Poultry, lamb, fish, etc. are left in, with some exceptions.

While I think you could easily argue that the opening phase is overly restrictive, the heart of this diet is clearly in the right place, with its focus on moving in the less-processed direction, more fruit and veg, paying attention to food quality and a lot more attention to our body's responses to food (eating rather than drinking calories).

There's a chapter on intestinal flora that is okay -- not great but okay.

There's a chapter on omega-6 to omega-3 fat ratio. This chapter exposes a lot of typical problems with this kind of nutritional advice. In theory, if you thought the omega-6 to omega-3 ratio was a really big deal, canola oil would be looking pretty good. However, the anti-processing/suspicion of chemical anything turns out to win and she opts for olive oil instead. She argues for leafy greens and wild berries, because they have more omega-3s, but it isn't like these things have that much fat in them anyway. And then basically eat flax, chia and hemp seed (this is the same woman who said _don't_ eat cottonseed oil because it's not a food. Ha!), and "wild, coldwater fish". I've become less and less convinced this ratio is something to worry about every year that goes by (sat fat has some pretty clear problems, by contrast).

There's a chapter on antioxidants: don't try to take pills, this is why to eat fruit and veg, smoking is bad, alcohol is bad, not enough sleep is bad, charred/burned food is bad, organic is good, plastic is bad, antioxidants from whole, (relatively) unprocessed foods are good, supplements are bad. Pretty straightforward.

There's a chapter on toxins and the liver, which is more or less what you would expect, right down to the There's Still DDT in Everything. The theory here is that by eating more fruits and veg, you've moved down the food chain so there's less bioaccumulated awfulness in what you are eating. Probably true ... but then why the Eat Fish recommendation? Sure, farmed fish is worse than wild caught, for the most part, but coldwater fish are particularly awful for bioaccumulating mercury. She does have the sense to acknowledge that conventional fruit and veg are still healthy for us and notes that, for example, human breast milk, despite toxins, is still really really good for babies. So there's that. Also, she isn't advocating some purge/detox thing, but rather more of the advice throughout the book: berries, fruits, veg, also things that make you sweat to clear water soluble so the liver can move on to other stuff, onions, garlic, mushrooms, fermented foods (no she does not mean beer), seaweed on the theory that these things feed supportive microbes, citrus peel, forage for wild greens and exercise in general.

Honestly, given how many odd things are sold as ways to Fix the problems she is describing, her approach looks fairly innocuous.

Next chapter is insulin resistance; I'm off to have some dinner that will likely be very non Abascal Way. Will update later.
walkitout: (Default)
I don't actually have any idea if I have a penicillin allergy. However, when asked if I have any allergies to medications, I do mention that I have always had horrendous GI effects from taking *cillins, and for whatever reason, it winds up on my chart as an allergy. I just won't take *cillins which are prescribed to me (sort of a moot point these days, because I've reduced the going-to-the-doctor to the point where no one has a chance to prescribe me anything. Huge improvement all around and much cheaper, too) anyway. I do have _lots_ of other allergies, however, including a shellfish allergy (not all shellfish: crab, prawns, lobster, shrimp, etc.) that leads to hives and monster migraines and GI problems; milk products cause GI and respiratory problems and a list of other things that I try to avoid because they seem to trigger respiratory problems and really, why go there?

Anyway. My husband sent me something recently asserting that penicillin allergy was over reported, and I was skeptical, however, here is an interesting development. Someone did a bunch of skin testing!


Initial N = 225. People who had a health record stating they were allergic to penicillin.

"Patients on antihistamines and beta-blockers were excluded from the trial."

This got them down to 206. They skin tested them. 201 did not have reactions to the skin test.

"A cohort deemed likely to benefit from penicillin therapy was prioritized for inpatient testing. In patients who were nonreactive to both tests, a penicillin G test with 500 mg of oral amoxicillin challenge was administered."

The size of this cohort is not stated in this summary (is it the 206? Or something else?). Of this group, one person reacted to saline (!). 10 people had a negative histamine test (what does that mean anyway?) and were removed.

Overall, out of the 206 that survived from the original 225, only 5 had positive reactions to skin testing. Everyone else got the label taken off their chart and could be prescribed *cillins. The idea is NOT just to save money -- some of those other abx have really disturbing side effects (altho not as bad as dying from a penicillin allergy, presumably).

I am, however, a bit flummoxed. On the one hand, I'm sort of tempted to go in for skin testing now. On the other hand, I'd have to completely go off allergy meds to do so. So. Hrm. Maybe during one of those months when I'm super ambitious and am not reacting to anything at all.

ETA: Here is an explanation of the saline and negative histamine test results and what they mean when doing allergy testing. Basically, the people who did this study did the study according to current best practice skin testing practice.


And let me tell you, back in the 1980s, they didn't do it this way, and I suspect that's why I knew a couple people who were allergic to everything (even things they said didn't bother them, but which skin tests showed they were allergic to). Nice to know they're getting this all sorted out!
walkitout: (Default)
AGAIN, just because I'm posting about something does not mean it has anything to do with me!

Anyway, I get MedPage Today updates, sort of by accident, but I never turned it off because there's some good links in there pretty consistently. Today's link of interest was a long form piece on Mosaic that was absolutely not worth my time. The Medpage Today link promised science, and the first half was first person narrative of agonizing emotional experience. Then the next bit was the same-old-same-old on there isn't much to do about multiple miscarriages except in rare circumstances. And then _finally_ a few short paragraphs on the actual science. An unfulfilling tease!

But it did give me names to google and THIS summary is worth reading.


The basic idea is that we've recently discovered that nearly all fetuses have some kind of genetic "abnormality". So ... maybe it's not the fetus. Brosens and Quenby (those are some awesome names right there!!!) went looking at the lining, and discovered that women who have multiple miscarriages have uterine lining that is very receptive to implantation. Maybe a little _too_ receptive to implantation.

"Put differently, to be successful, the lining of the womb (endometrium) must be ‘receptive’ to implanting embryo but also ‘selective’. In RPL women, the lining of the womb appears excessively receptive (‘super-receptivity’) but insufficiently selective. Hence, many of our patients report that they find it very easy to become pregnant (‘super-fertile’) but then fail to hold onto the pregnancy."

So far, so good -- matches one of the folk theories of miscarriage okay.

"we showed that IL-33/ST2 activation is both prolonged and disordered in endometrial cells from RPL patient. As aforementioned, exposure of mice uteri to these signals prolonged the implantation window in these animals, allowing out-of-phase implantation and resulting in early pregnancy loss."

So they've identified some of the biochemistry of the dance of implantation, and identified at least one major issue with it in women who have repeated miscarriages. AND THEY CAN DO THIS TEST BEFORE YOU EVER GET PREGNANT AT ALL. Which is pretty amazing, right there. " it is possible to develop tests that predict prior to conception the likelihood of pregnancy complications."

The future holds wonderful prospects! They are hoping their work on the womb's side of the pregnancy developmental process might also lead to insights into fetal growth restriction and preeclampsia. That might be a little optimistic, but I'm so happy that smart people are tackling another component of this complicated and super important area of research.
walkitout: (Default)
I've been reading a lot of different things lately and NOT blogging about them, for a variety of reasons. Here's today's trigger for blogging:

Every election season, somebody, somewhere, feels compelled to diagnose one or more candidates with mental health issues. And it is SO EASY! Because if you are running for president, you probably have some combination of three things going on:

(1) You think you're right for the job. (Megalomania, delusional thinking, narcissism)
(2) You think the country needs you to do the job. (martyr complex, savior, codependency)
(3) You've never met any form of attention that you didn't just LOVE! (see (1), and probably plenty of other things)

Over time, our therapeutic framework has evolved, and so we call similar clusters of "stuff" by different names. This time around, Trump has a personality disorder that once would have been called narcissistic personality disorder, but is now lumped in with a bunch of other stuff. VF is inadequately respectful of this evolution -- I'll get to that in a minute. Or, you know, maybe never if I forget.


As long as we're clear that I'm not endorsing _anything_ in that article, please feel free to enjoy it. It's very funny. Altho I've lost the last vestiges of respect I once had for Howard Gardner, who has apparently never encountered reality TV, and especially not WWE.

I would instead like to focus on one George Simon. I think the George Simon quoted in the article is this guy:


And let me just say, I'm not sure this is the guy I would go to for expertise on narcissism, unless, you know, you think someone with some experience at it from the inside is a good plan. He got his degree at Texas Tech, which brings me to another bit of reading (much more serious) that I ran across lately:


Really good article, very nuanced and balanced. Also, very sad. Texas Tech gets a mention in this article as an example of a place which is such a desert of information about reproduction that it has an STD with its own name: Raider Rash. Oh look! It's in Urban Dictionary!


Urban Dictionary's understanding of the term is a little different than CNN's -- I think I believe Urban Dictionary's understanding more than the article, actually.

Texas is also home to the Castros, Julian, widely rumored as VP pick if HRC gets the nomination:


and his twin brother Joaquin:


Their mother was a political activist in the past, including in a regional third political party in Texas.


Nice picture of her and her boys! And their father was involved in community organizing as well.

Texas is a big place, full of big egos (which the Castros show no real evidence of having), struggling with an enormous demographic change, and at the center of a major Supreme Court case involving what kinds of regulations with what kinds of intentions and what kinds of results can be applied to clinics which offer reproductive service. Once again, Kennedy is likely to be the swing vote, and he's taking an interesting perspective on the whole thing.


He doesn't seem too happy that an effect of this law is to move Texas in a direction opposite to the rest of the country: reducing medical abortion and increasing surgical abortion (presumably due to the delays and problems of access that the law creates).

“My reading indicated that medical abortions are up nationwide, but down significantly in Texas,” Kennedy said. “This may not be medically wise.”

Honestly, when you have a major candidate for the Republican nomination for POTUS, and everyone is going on and on and on about how big his ego is (or how narcissistic he is or whatever we call it these days when a guy is just way too full of himself, too much of a blowhard and too inclined to talk up the size and caliber of his Manly Parts -- and attack everyone else for the size and caliber of theirs) and he's NOT from Texas, in a year when Texas is so much at the center of the universe, well, that's kind of interesting, right?

Because door number two -- sure, he was born in Canada, whatever -- is FROM Texas! And he's on the ban abortion side of things. That's kind of more how we would expect this to go. And yet, he's the young guy on the side of an argument that is at some sort of tipping point.

It's a weird, weird election cycle. When the too big guy from NY is beating the young guy from Texas, and the guy from NY has a string of marriages and can't correctly verbally express second corinthians -- really, how hard is _that_? -- that guy is kicking ass and taking names. The opposing team is engaged in a brutal elimination battle, trying not to self-destruct and let that guy win it by default, the swing voters who incline to social liberalism and can't tolerate a blowhard are looking at Mayor Mike -- another NY billionaire -- and wondering if he might save them.

A lot of people are openly talking about what all this means for Mental Health in America. I mean, geez, if people are crazy enough to like Trump!?!

At least we're talking about it. If we took our 2016 eyes, and pointed them at previous election cycles, I'm pretty sure we'd be a lot more critical of them than people were at the time. It's not that we are that critical as a set of voters, or even in that critical of a mood, or at that terrified a point in the business cycle.

It's just that it's so _easy_ to share our criticism, our witty, clever, entertaining criticism, that makes us look _so, so smart_. And so we do. Which I don't see any particular problem with, altho I do hope that when the dust settles, we'll all pull back up out of the hyperbole and go back to some semblance of calm.
walkitout: (Default)
Again, just because I'm writing about something, doesn't mean it actually involved me personally.

So, contemplate a person with a severe food allergy. It's not the worst possible scenario (airborne and lifethreatening anaphylaxis) but it's pretty bad: severe hives, respiratory implications, etc. Or maybe it's not a food _allergy_ per se (a protein triggered IgE reaction), but some other kind of food intolerance, and the manifestation is bleeding sores on contact (and let me tell you, bleeding sores on contact in the esophagus and similar is nothing to mess around with. Never mind the rest of the alimentary system).

Let us assume that as an adult, the person with this severe food issue has more or less identified what they absolutely cannot eat, and over time, they've figured out where they can and cannot go out to eat and so forth. They have more or less mastered the intricacies of talking to servers and coaxing the servers into talking to the kitchen -- and they've gotten really freaking brilliant about tracking down online ingredients lists and so forth, and become quite expert at the typical construction of anything they've ever eaten and most of the typical variations. They still are periodically sent to the ER by a blithely incompetent server, or an overly creative kitchen, but they mostly have it under control.

Now let us give this adult a person with whom they enjoy physical intimacy. They kiss. They lick. Maybe they bite. Etc. All over.

I now know two people with food issues who have to pay close attention to what the person they enjoy physical intimacy with is consuming, because that person's mouth is a cross contamination hazard.

This is so incredibly unfair, on so many levels.


Super Lice

Feb. 28th, 2016 04:21 pm
walkitout: (Default)
I had no idea this had happened, but I guess I should not be surprised. There are permethrin resistant lice. Yuck!

So, screw that pesticide crap anyway, and ditch the comb. Get yourself to a licensed AirAllé / Lice Clinics of America and (as long as you're old enough and don't have contraindications) get the hour long heat treatment. Assuming you can avoid reinfestation (like from family members, so maybe have everyone done at once, or at least be assessed), it's one-and-done, and there's no reason to believe lice, "super" or otherwise, are going to evolve some sort of resistance to desiccation.

Inconveniently, the Seattle area option is on Bainbridge. There are numerous Boston area options. The Lice Clinics of America has a finder feature on their website.

There are lots of other things you can try, of course, but this is the first time I've ever run across anything that has had clinical testing (FDA approved!) and a guarantee.

ETA: Standard advice is to quarantine clothing and bedding for some unreasonable amount of time and/or run it through a dryer on high for 30 minutes to an hour. Judging by Ms. Flynn's research on ticks, I'm betting the already VERY low risk of reinfestation of lice from clothing and bedding can be reduced to zero with a lot less time than that in the dryer. 10 minutes on low will probably do it.


Re: my husband's remark about shaving his head. Yeah, sure, but he does that occasionally anyway. _I_ would shave my head, too (at this point, I'm just looking for a good excuse anyway). But asking children or people with long hair to do so is probably cruel.
walkitout: (Default)
Go read it -- I'll wait.


There are a lot of articles/books along these lines: do some weird thing for a week or a year, log everything, describe what you learned. I tend to prefer the one or two week experiments over the month or year long experiments. Probably because there isn't THAT much to learn over the longer length of time and yet the word count goes up so much.

Predictably, the woman who undertook this experiment discovered that keeping sodium to a reasonable level was basically impossible with this plan. She _did_ discover some other things as well.

(1) Customizing helps. I'm not sure I've ever been to a Taco Bell, so I didn't know about the Fresco option (swap the cheese, sour cream and rice for pico de gallo, is how she describes it -- it may be more complicated than that).

(2) Choosing healthy options such as salads, kale style, etc. results in undershooting on calories. I have a theory about this: the only people who historically have been eating this kind of fast food were mothers of children who wanted fast food, and the mother had given in and eaten there also. And she was perpetually dieting. The 1200 calories plus or minus that the author keeps winding up at (she wasn't aiming that low) is roughly in line with what a dieting boomer woman would have been shooting for over the course of a day in the past.

(3) KFC's problems are worse than KFC realizes. In her case, she discovered she couldn't swap the sides for healthier choices, which imo would explain right there why KFC has been having so much trouble with younger customers. No customization, no healthier choices is lethal. But then on top of it, she ordered grilled and was served fried. W.T.F., KFC? I don't think I've ever eaten at a KFC, either.

And yes, fast food IS cheap and convenient.

I'm super happy that Kate Taylor did this and wrote it up in an engaging and thoughtful way. Fast food should be able to produce real options (enough calories, not such insane amounts of sodium, some degree of customization to cope with dietary constraints whether religious, allergy, lifestyle, etc. in motivation). And several chains are really working hard to accomplish this. If we as a society are going to be eating out with $.50 out of every food dollar spent, then fast food needs to meet some kind of minimum health bar. But as long as we keep pretending that fast food is some kind of guilty side thing that isn't part of our Real Food Supply, the pressure to make this happen is going to be erratic and ineffective.


Feb. 9th, 2016 11:46 am
walkitout: (Default)
So, I get that everyone is working up to a total freakout about Brazil, the Olympics, etc.

However, I noticed this.


It's mostly about dengue in Hawaii, which is a problem. However, it includes this:

"Last month, a baby born with brain damage at a hospital in Oahu, Hawaii, was apparently the first case of the mosquito-borne Zika virus in a birth on U.S. soil, health officials said."

And that makes me go, wait. How sure are we that all that dengue in Hawaii is actually dengue? Because misdiagnosing zika as dengue is _common_.


"The disease has similar clinical signs to dengue, and may be misdiagnosed in areas where dengue is common."
walkitout: (Default)

Long, but worth the time.

Highlights include: increased snow leads to increased salt changes the chemistry of the ground water, leads to lead leaching. Lansing is wrapping up replacing all its lead lines. For a while, they were encountering resistance from property owners. Not after Flint. Discussion of other water issues beyond lead.

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