Friday, December 24, 2010

the placebo effect and IBS

A recent study from Harvard Medical on the placebo effect in IBS patients.  My thoughts can be found here.

Saturday, December 18, 2010

Dear Remicade, and other stories

This morning's Remicade excursion began like any other, with a cold, dark and barely-awake drive to visit my second home.  Michelle and Wish, my regular infusion center nurses, perked me up with chatter of new serum biomarkers,  holidays and my veins.  Feeling extraordinarily adventurous today, I opted to give my poor inner elbows a breather in favor of a more fancy-pants IV site: the wrist.  Though I have what is probably an unhealthy comfort with needles, IVs in the back of the hand and wrist have always weirded me out.  It was, to my great amusement, very classy.  Michelle even put a bit of gauze between the needle and the tape so as not to rip out the tube too harshly and invite the typical mess due to the allergic reaction I have to the tape itself.

Wish inevitably asked about my ear, and I refrained from extrapolating my theory of an organism from an alternate universe in favor of the more benign, "this is seemingly a consequence of a suppressed (oppressed?) immune system."  Though it has been a noble fighter in the past, my line of defense is whithering to a sad benched quality -- thank you, Dear Remicade.  In no uncertain terms, this drug has saved me from regular excruciating pain and replaced it with an irritating inability to fight off much of anything that assaults me.  The Colony has by now expanded into my hairline, around the lobe of my ear and is creeping down my neck and onto my face in an inglorious manifest destiny. (Because I have been bragging about this for three months now, I feel that I owe you:)
Gnarly, eh?  Conscious of keeping this blog PG-13 rated,
I sopped up the leaking blood and serum for you.

If it gets to the point where my eyesight is threatened or I fear it will otherwise interfere with graduate school interviews (one acquired, four to go), I may invoke a short-term Prednisone stint in effort to fight the inflammation that not antibiotics, hydrocortizone, athlete's foot cream nor hydrogen peroxide have been able to defeat.  The Derm appointment is only ten days away (my birthday present to myself!), and I count the days (sometimes broken into 8 hour segments... no joke).  We shall see if he supports my Steroid Hypothesis.

Meanwhile; bladder is fully functional, intestines are in agreement with the current diet (even with a few holiday indulgences), night sweats are somewhat controllable or at least don't wake me up as often, and the nasal exoskeleton with its tremendous stores of green mucous continues to subside with the help of Nasal Crom.  Progress, though painstakingly slow, is finally observable.

Sunday, December 5, 2010

of frump and holidays

What I love about starting a business is that it is organization intensive.  I don't get to coordinate the lobbying or event logistics or portfolio presentations since I stopped working with the CCN, so I thoroughly enjoy my obligatory role in helping H.K. in his new entrepreneurship.

Most peoples' living room floors are peppered with holiday gifts in various stages of wrapping.  Mine, for the last month, has been drowning in bags, and bags, and bags and bags of Legos.  Today, H.K. and I made a two-trip purchase of no less than 28 Sterilite drawer bins into which all the Legos in my living/dining room are currently being transferred.

For the occasion, your humble narrator appeared in public in unwashed 80's hair, tweed coat and scarf, and sweatpants which, being new and tightly cuffed, showed off the fashionable white Puma socks whose tops were exposed above my Dansko clogs.  Stylin'.

During our second trip, a gust of wind caught both our over-filled carts rounding a corner of the store and blew three of our drawer bins out of the carts, sending one flying into the street in front of a car who was, to our great fortune, actually going 5 mph around the corner and stopped before annihilating our merchandise.  I was then obligated to surrender my coat to weigh down the bins as we proceeded onward to the car.  Now decadent in a near-fluorescent orange T -- which matched my sweats but was quite Hobo-esque with my scarf and flying frazzled hair -- and coat-covered shopping cart, I booked it to the waiting vehicle.  Let it be known that H.K.'s sweatshirt-adorned cart looked less Hobo than mine, and he, being in jeans, suffered no humiliation.  Also let it be known that I am quite proud of my performance in 30 degree sunshine.

We attended a dear friend's birthday last night, at which I indulged in fruit salad made with coconut milk, gluten-free tirimisu sans the marscapone icing, and chips.  And now, here I sit in my much-more-fashionable matching regal blue robe and slippers sipping Earl Grey and waiting for my fiber cookies to kick in.  For the last two nights I've been woken up (unsurprisingly) due to abdominal pain (shockingly).  Could it have been the latkes?  Could it have been the vinegar in the pumpkin chutney (a scrumptious gift from my wonderful coworker)?  Could it have been the halibut (gasp)?  Who knows.

Fortunately, Chanukah is not a bust.  On the third night we finally pulled our (read: my) act together to feast in the warmth of our new robes, lit candles and obsessively decorated home, while watching Beauty and the Beast on blu ray.  Fairly epic, but now H.K. is feeling the pressure to get me a giant library for my birthday.  To clarify, that is external pressure from yours truly, not internal pressure.

Thursday, December 2, 2010

on exercise and health

I am not well.  The adrenaline from the conference has worn off, and in the bombardment of the holiday season I find myself sinking.

The CT scan of my sinuses revealed an osteoma, which is evidently of no concern because it is not causing obstruction.  Therefore, I continue to mollycoddle my nasal pathways and oblige the constant flow of green mucous.  My ear colony, which is either fungal or an exiled celestial community, has responded to its daily chemical assaults by growing over the last two months.  Touché, Ear; I will be taking you to the Derm in a few weeks.

I think that it has been so long since I slept through a night that it doesn't bother me as much anymore.  And by doesn't bother, I mean it doesn't keep me from going to work every day, or shopping or cleaning or getting other things done.  What it does do is keep me from getting to work on time, being any degree of efficient, and enjoying anything that I am doing.  In brief, I pretty much feel like I'm hanging on for dear life until around noon.  For the rest of the time, I am a confused drone.

"Are you exercising?" my doctors ask.  By the way, I've also been to no less than 13 medical appointments over the last 2 months.  In a pleasant twist, none of these appointments were related to abdominal misery.  Hooray?

"Yes," I answer, mentally rolling my eyes, crossing my legs and preparing to explain to whichever physician I am seeing that day what exercise actually does for your health.

The endorphins!  Physicians pedal endorphins like they are the Western version of harmonizing one's Chakra.  Endorphins and metabolism-boosting are the more direct effects of exercise, and why it is the physician's favorite shout-out.  And while I have no arguments with the widespread benefits of physical activity -- it is 50% of my own research, after all -- it is certainly not a therapy without caveats.

In Parkinson's disease (PD) research, in which I am most fluent, it has been the general finding, although uncommonly published, that voluntary exercise has more positive effects on gait and neuropathology than does forced exercise.  Observations lead by Dr. Carl Cotman at UC Irvine have shown that PD patients guided in treadmill exercise received minimal improvement.  In other studies, aging canines taken for walks and given the opportunity to explore and run displayed great improvement in gait, cognitive ability and initiation of neural growth factors (2, 3).

A study was recently published in the British Journal of Psychiatry surveying the effects of "leisure" or "work" exercise (i.e., voluntary versus forced exercise) by Harvey et al.  The implications of the study are very aptly presented by one of my favorite neuroscience bloggers, Neuroskeptic.  What the conclusions amount to is that forced exercise does not have the beneficial effect on depression that voluntary exercise does.  People who got exercise through their labor-intensive jobs did not experience the positive changes seen in people who chose their own exercise on their own time. 

Therefore, the study suggests that it is not just the physical activity that is important to the therapy, but the interest in engaging in it, and the feelings of accomplishment, etc., that help a person achieve positive results.  This has been the case for me my entire adult life: when I enjoy physical activity, it helps me get through the day, it helps my mental state, it makes me feel better about myself; but when I do it out of sheer guilt and obligation I get absolutely nothing out of it.  As a woman who spent the majority of her life in competitive gymnastics and dance, this is not a new subject for me.

So yes, Dearest Physicians, I do exercise.  But I do not do so when I feel like I am dying.

My physician looks at me, puzzled.  "You know, if you make sure that you exercise consistently you will have better results.  I want you to try to exercise more often, even if you're tired in the morning."


Sunday, November 21, 2010

SfN 2010

As I sit recovering from a week of travel, rich food and constant bombardment with science and brilliant minds, I can't help but feel proud of my restraint.

I paced myself well, got a bit of sunshine, and suffered from not a single Crohn's attack.  There was a great deal of rich food at my fingertips.  Several days begged for lunches out in downtown San Diego, as >31,000 neuroscientists poured out of the convention center and into the streets to acquire sustenance for the afternoon's activities.  Our lab was also cocktailed, wined and dined by a very lovely medical liaison -- just a wonderful woman -- which called for rich Italian food. 

Fortunately for the intestines of yours truly, San Diego is brimming with fresh seafood.  I even ventured to eat three stunningly delicious prawns and had no backlash.  Nausea was minimal, throughput disconcertingly normal, and energy manageable.  I ate scallops with mushrooms, kale, pomegranate seeds and pumpkin puree (butterless).  I ate mahi tuna sliders with ginger (creamless, and oddly low in oil).  I ate mussel and clam capellini and, randomly, amaretto and cherry liquor coffee with biscotti.  I survived, I suspect, because rich meals were limited to one a day; other meals being oatmeal or Odwalla protein bars.

Unsurprisingly, I arrived home fatigued and drowning in adrenaline.  We flew in Thursday evening, and work the following day was driven by excitement and seemingly uninhibited by exhaustion.  Thank goodness for a weekend empty but for catching up on crap tv, football, laundry and blogging.  I am not -- I repeat not -- ready for the onslaught of Thanksgiving-Hanukah-Christmas-New Year-Interviews.  Chuck Norris, help me.

A beautiful and enriching trip.  Feel free to see my science blog for details.

Thursday, October 28, 2010

in which i grow tired

Well, I am broke.  Thus far in October, I have had eight separate doctors appointments spanning five doctors.  I have three more -- count 'em, three -- this coming Wednesday before I head south to Willamette U. to be on a career panel for up-and-commer scientists and then get infused with Remicade before flying to San Diego for my first major conference.  With all due gratitude to my government bosses for providing excellent coverage for their employees, never underestimate the paycheck-dissolving power of copays and prescription fees.  I can no longer afford to eat sushi twice a week.  Woe is me!  My bedside table is officially over flowing with all my vials of drug, and I'm not entirely sure that my body is tolerating them either.

However, our home is thoroughly draped in Halloween splendor and this Saturday's party -- whether or not my guests decide to appear in costume, ahem -- will be well-worth the cooking frenzy (let's not kid ourselves -- I am not above a last-minute run to Costco to make sure the meal is edible).  And Sunday... Sunday is reserved for horror flicks and football.  Hell.  Yes.

The cycle has snowballed, and I am, as yet, uncertain whether it is calming down.  Despite all the more tangible symptoms, the fatigue is what is most getting in my way.  Because of the fatigue, I don't run in the mornings.  When I don't run in the mornings, the depression comes on all the more easily.  When the depression sets in, I don't sleep because I spend the evening terrorizing and bloating my sinuses.  When my sinuses are bloated, not all the sinus irrigation/flonase/sudaffed/fexofenadine or promethazine in the world can help me sleep.  And when I don't fall asleep, it doesn't matter how many times my bladder forces me to get up through the night.

Where is my colon in all this, you ask?  It's fidgeting on the sidelines trying so valliantly to get onto the field.  "Lookit me! I'm giving you car sickness every morning and every afternoon!" it wails, "I'm giving you the most delightful smorgasbord of Throughput and you're not even paying attention to me!"  Alas, my loyal companion, you have taken a back seat to other -- dare I say, more pressing -- issues.  Never fear; your time in the lime light will come again soon.

Sunday, October 17, 2010

the Fall and the full

 Halloween approaches, and so I begin my ritual of orange-food gorging, pie making and home-spookifying.  This year, I have inherited a few decorations from my mother; among them, a porcelain child in ghost costume holding a glowing Jack-o-lantern which so encompasses all of my warm childhood memories of this very important holiday.

In honor of this conferment, and of all the new drugs I am on, I have decided to throw a small Halloween party this year.  To hone (read: stumble embarrassingly through) my hostessing skills?  To give my apartment some personality and to fill it with warm and spooky company?  Because I am feeling well enough to truly enjoy the season?  Perhaps all of these are their own motivation.  However, it's mostly because I want to make edible eyeballs out of lychees and grapes and hide them in peoples' soup.

In the spirit of the winter season, the beautiful rain, and my venture back to a balanced state of mind, I have visited enough doctors and filled enough new prescriptions lately to account for well over half of my paycheck.  The elusive urinary tract syndrome, which has been addressed by GI, primary, OBGYN and urologist is being treated with yet another antibiotic which seems to be at least participating in warding off the next episode.  The outer ear infections are being treated with antibiotic as well, and the crusted plasma-oozing sore behind my right ear is being treated with a clever combination of cortisol and athlete's foot creams.  The dermatologist assigned to me The Next Big Thing in acne antibiotics and tried to convince me to try Accutane (yes, on Remicade.  yes, I rolled my eyes at him and explained what Accutane is, what Remicade is and what a liver is).  My nasal exoskeleton is on its third (or fourth?) week of the Allegra-Flonase-Sinus Irrigation trifecta and is being admirably defeated (read: the reasons I don't sleep at night are no longer because of my inability to breathe).  And lastly, I have been put on sleeping medication as a first serious approach to overcoming this ghastly depression which has been pwning me since July.  Promethazine finally procured although it took a month to convince my GI that the vomiting actually is impeding my ability to work (that's a lie, because work is going exceedingly well, but what's a girl to do?).  Now I just need to go to the dentist.  When I get my next paycheck.  And if I don't first spend that paycheck on Halloweeny Essentials.

This body is currently full with drugs.  Damn antibiotics for working far better than any Astragalus, Ashwaganda or l-theanine supplements I've ever taken.  H.K. remains, of course, my most effective medication.
This weekend, we acquired several very large and very face-friendly pumpkins.  Hamicar and Toby remain faithful guardians of our domain, although only when the sun is out.  Next weekend, H.K. has nobly volunteered to help me experiment with the Halloween menu items so that I don't kill any of my guests.  Successful recipes will be posted.  Unsuccessful recipes will probably also be posted.

Wednesday, October 6, 2010

This is Hamilcar

For all who enjoyed meeting my pet spider, Toby: this is Hamilcar.  He is a hybrid Carthaginian Amazon spider who has made a home catty-corner to Toby in our doorway.

Hamilcar dwarfs Toby by roughly 2.5x; he is brown and orange and hairy and he scares the shit out of me, but he is the size of my eyeball so I have no intention of messing with him.

Monday, September 27, 2010

the besting of Hell Month

August was wretched.  Full of deadlines and uncertainties, and brimming with uncontrollable outcomes -- many of them broken or bad.  August was Hell Month.  And what's worse: Hell Month so viciously consuming the soul of your humble narrator, there was no relief to be had (not that there were not opportunities; there were plenty begging for attention, but despair would not yield).  Poor H.K. knowing not what to do with the sack of melancholic potato that had replaced his wife, did his very utmost to provide rejuvenating intervention.  How he survived, I will never know.  'Patient' doesn't begin to do him justice.

September.  We both held out for September.  That beautiful transitional month where all students withdrew to their various institutions of edification.  When all manuscripts would be submitted, new projects begun and peaceful nights at home would ensue.  September failed me, and with manuscript rejections compounding the anxiety over That Test and the extemporaneous decision to apply for a massively competitive grant, I wobbled, and then collapsed.

But as September closes, Hell Month Part II is daring to show only its last fading embers.  There are still projects, manuscripts, grant writing and applications, but these are what I live for.  Well, I mostly live for H.K., but secondarily I live for science.  With That Test out of the way, 99% of my burden is alleviated, and the rest is more than manageable.  In fact, there is even time for Experimental Cooking and playing outside.  And so it would seem that Hell Month has finally been bested.

 This is Toby.  Toby resides above the shrub adjacent to our front door, and has greeted us every morning and evening with his magnificently large web, which is consistently inhabited by some poor large insect about to be devoured by this disconcertingly large spider.

 This is Toby snacking on a giant grasshopper.

Currently, there is only the growing nausea and this four-month drawn out allergy disaster to hold me back -- and they are weak contenders if ever there were any.  Remicade has given my immune system a startle, and it did not remember how to handle allergens when they came about this season.  Since June, I have had a nasal exoskeleton and a nasal cavity effervescent with green mucous.  For two weeks, I even developed an aversion to mice (a career-ending obstacle if permanent; please appreciate the potential gravity).  The most recent diagnosis last week was "you clearly do not have an infection, so take everything together, and if it still doesn't work we'll give you an allergy shot!"  Brilliant.  To clarify, three weeks of Allegra, Sudafed, Flonase and sinus irrigation (otherwise known as drowning without involving the lungs) should do the trick.  In theory, I should be sleeping again, not nauseous and not having post-void residual problems like a man who just underwent prostate surgery.  We're a third of the way there, folks (because I am now sleeping from 11pm-5am!)! (!)

This evening: my attempt at Falafel Waffles.  Though a half-failure, my chickpea-lima-chive concoction was also half delicious.  It was very dry and crumbly, but would have been oh-so delicious with the appropriate sauce.  Inevitably, no matter how crucial to the recipe, I forget about the sauce.

 You can already tell how dry...

Falafel were meant to be deep-fried balls of internal soft moistness, and had I tossed them in a vat of boiling oil, they may have been just that.  Although I followed Lisa's recipe to the last detail (excepting the cilantro and parsley... and the sauce), I could not make them puff in the soft way that Black Bean Cakes or Polenta do.  I'll get you next time, Fawaffle... NEXT TIME!

Sunday, September 26, 2010

on reclaimng life

Having gotten through the most terrifying aspect of this season (the GRE), and having experienced the worst case scenario (not only unimproved, but slightly lower scores than last year... when I was high, nauseous and in pain), I am successfully emerged on the other side of doom.

Oddly, I am less bothered by average scores than I expected to be.  The relief of its being over with is much more potent than the disappointment with my performance on this particular exam.  Frankly -- and I'm not alone here -- I regard that test as far more highly referred to by graduate school admissions committees than is wise.  That said, I am acutely aware of how biased, political and funding-based the admissions process is in general and, therefore, am aware that average test scores will not be my undoing.

That is, of course, unless my average scores prevent me from being invited to interviews.  The thing is that highly prestigious schools will triage applications to the discard pile if they are not at a particular level.  Here is why I think that is a complete bullshit filter for applications:

This summer, I had the privilege of teaching several intern students.  Two of them were at he high school level, and were very fun to teach because they were fledgling scientists with lots of interesting questions and a flare for the work.  At least by the end of the summer, when the results of their month-long project started trickling in, their enthusiasm was wonderful.  This is why I love teaching.

In another vein, however, I had the privilege of teaching some biochemical techniques to one of our veteran students who has been doing analysis in another part of our lab for three years, and whom we had come to regard as a genius.  This student happened to be entering his senior year as a Biochemistry major, was applying to graduate programs, and was using his last summer month with us to buffer his resume by learning some new techniques.  He was, for all intents and purposes, my peer.

He was also a complete dolt in the lab -- more clumsy, less interested and with the worst memory I had ever seen in a person, scientist or otherwise.  I was completely taken aback by his lack of apt for deduction (read: common sense).  Please understand that this is not an exaggeration; I was shocked and befuddled that teaching my peer was like teaching a kindergartner.  I had to cut in half what I had planned on teaching him in that month because he could barely handle what he was initially tasked with.

How this boy could possibly be an academic genius became more and more puzzling.  Yet, his GRE scores trumped mine.  And he will be invited to interview at Stanford (yes, he is applying to the exact same programs that I am), and I will not, because his scores are higher than mine.  He will bomb his interview, because he knows almost nothing about what he's been doing for the last three years, and has very poor social skills (for which I do feel bad for him), but he will get them, and a small part of me dies whenever I think about that.  Despite this, he may actually be admitted to programs that I am rejected from because the more prestigious the school, the more weight is put on his exam scores.  I have effectively buffered the resume of a boy who, for all his pompous yet oblivious innocence, will never be a decent research scientist much less a Stanford-grade one.  What's more, he has no idea why he wants a PhD; it's just another step in the academic achievement track.  And this, as I studied for my own second-go at the GRE, was infuriating. 

However!, having faced my worst fear and come out the other side, I am happy with whatever school I am accepted to because I know what I want and what I'm doing, and will be a huge asset wherever I end up.  Whatever I want to make happen with what I'm given will happen, because that is something I've consistently been good at.  Getting into an amazing school instead of an average one, however, would be much welcomed reassurance that I belong in this field.

I could write volumes on how to best approach finding a graduate school, preparing yourself, exploring options, what the GRE actually says about your scientific potential, and negotiating the politics of science, but this data dump is dry enough as it is.

To end on a pleasant note -- and I must, because I feel better now than I have felt in two months -- this weekend was beautiful!  I worked on my grant while being infused for four hours on Saturday, stopped at New Seasons to pick up special sandwiches on the way home, and took the bikes and Frisbee out for some exercise at the park for the afternoon.  It was freeing, and wonderful to be able to throw myself back into real life. 


Today, I will finish my next manuscript and make some progress on applications having filled my tummeh with my new favorite Lisa-inspired breakfast: waffled eggs with chive Tofutti and onion bagel.
I feel good.

Tuesday, September 21, 2010

on waffling

One of my most favorite wedding gifts was from Lovely Lisa.  Leave it to the Waffle Wizard to bestow upon me a waffle maker of my very own.

Not only does my fancy new culinary instrument occupy perfectly that-one-shelf-space-in-the-kitchen-into-which-nothing-else-fits; there is just no topping the ultimate design of the waffle in terms of entree base.

This is one of my favorites.

Last night, I conducted my first experiment: waffled polenta.  It was simple, speedy and surprisingly delicious -- delicious in a reliable way, as if I could make this thing well more than one fluke time in my life.

Next up, "Fawafles".

  yes, this is, indeed, Tapatio sauce.

Protest all you like about how terrible corn is for the Crohn tract.  While cornbread, polenta, grits, hominy and cornmeal soup are all reproved in the common Crohn's or IBS diet, these are also gluten free foods, so if your reactions tend to be more volatile with wheats, polenta can be a benign substitute.  Cornmeal is also higher in fiber than wheat, and can be very helpful with Obdurate Throughput.  With Crohn's the clinical studies never cease to reveal that what is beneficial to one case is likely to be harmful to another, and there is no universally harmful food in Crohn's disease (Triggs et al 2010).