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."