- Well: Reasons Not to Panic Over a Painkiller
Tue Jul 07, 2009
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Tue Jul 07, 2009
Mon Jun 22, 2009
Melle shared this the other day — lovely!
I posted about swine flu a while back, before we really knew anything. Since the WHO just moved to stage 6 and declared it a pandemic, causing my RSS feeds to explode with yet more newshype, it seems like a good time for an update.
Stage 6 doesn’t mean the disease is getting more serious/deadly or anything like that, just that it’s now indisputably widespread. SARS, for example, was a very deadly disease but it wasn’t a pandemic since it was contained in a relatively few locations and we could track the chains of transmission. We can’t do that for H1N1 right now — it’s out there in the community, and some people who have it have no clear connection to anyone else who has it. Severity can be one indicator of a pandemic (the WHO seems to be waffling about that a bit) but in general it’s just an indication of the extent of a disease’s spread and not its lethality. Take home message: declaration of stage 6 is not in itself a reason to head to the back woods with two tonnes of tinned beans and a shotgun.
The BBC has a sensible quote from flu expert Professor John Oxford:
“It is global and fulfilling the requirements of a pandemic but I don’t think anyone should worry because nothing drastic has happened between yesterday and today.”
Initially it was looking like H1N1 might be up to 6% lethal. Fortunately, so far the numbers indicate that it’s much, much less lethal than that. Today the numbers I’m seeing show 27,737 official cases of swine flu, including 141 deaths. That puts the death rate at roughly 0.5%. To put those 141 deaths in context it helps to remember that normal seasonal flu, from what we can tell, kills upwards of a quarter of a million people every year and gets much less fanfare (not, of course, that it makes the 141 H1N1 deaths any less tragic). The Pump Handle blog puts it well:
The influenza virus kills people all the time. We don’t know exactly how many but we know that many people die of various immediate and underlying causes that wouldn’t have died at that time if they hadn’t become infected with the influenza virus in the period prior to their demise. Influenza is like heart disease or diabetes or cigarette smoking: a major cause of mortality that we have become used to. As long as it is described in terms of familiar seasonal influenza the public is all right with it — until they get a good dose of this really miserable illness.
It’s worth repeating that flu of any kind is deeply, deeply miserable, even if it’s technically “mild”. “Mild” in this context means “not terribly dangerous” and “not in much need of medical assistance,” not “a bit of a sniffle, continue with your everyday activities”. H1N1 sounds pretty similar to normal seasonal flu except it seems to involve some vomiting, which isn’t typically a flu symptom. So you have your usual week or two of flu-related extreme exhaustion, cough, bone aches, fever, chills, headache and all the rest PLUS hurling. Lovely!
But remember those 27,737 official cases were the folks who were sick enough to need to see a doctor or go to Emerg. There are probably a large number of cases out there where people just felt ill and stayed home without visiting a doctor, so their cases didn’t get counted in the numbers. This means the true death rate is probably rather lower than 0.5%. New York, for example, thinks they may have had about a half-million unofficial cases and only 12 deaths, which some mental math estimates is about 1 in 40,000. Canada has had 2,446 H1N1 cases and three deaths, so about 1 in 800 or 0.12%. Take home message: It’s always a good idea to have your affairs in order, but this flu is not all that likely to kill you, assuming you’re reasonably healthy to begin with and if you get medical help if you need it.
The CDC in the US put out quite a good press release detailing what H1N1 symptoms do indicate more serious problems:
In children, signs that need urgent medical attention include fast breathing or trouble breathing; blueish or gray skin color; not drinking enough fluids; severe, persistent vomiting; not waking up or not interacting.; being so irritable that the child doesn’t want to be held; and flu-like symptoms improve, but then return later with a fever and a worse cough. Those are warning signs we physicians think about all the time, with respiratory infections. And they’re good to have in mind with this new influenza-like illness caused by the novel H1N1 strain. Just good things for parents to have in the back of their mind.
In adults, we look at another set of warning signs that suggest the need for urgent medical attention: difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness, confusion, persistent or severe vomiting that doesn’t go away; and flu-like symptoms that improve, but then come back again with a fever or worsening of cough.
Of course, if you do have some sort of medical condition already (asthma and other respiratory problems seem high on the list), it’s a good idea to consult your doctor as soon as you might think you have the flu. Call first so they’ll be able to isolate you appropriately. You don’t want to be sitting around a waiting room or Emergency department shedding virus all over everybody.
So yes. Flu is no fun and at this point there’s a pretty decent chance lots of us will catch it, but it’s not an OMG WE’RE ALL GONNA DIE, DIE, DIE! thing. Wash your hands a lot. Maybe buy some extra freezies and clear fluids — you’ll get through them eventually and if you do get sick you won’t want to go out shopping (nor does the rest of the world want your germs). Maybe ride your bike to work instead of taking the subway (see, I can work a plug for bike commuting into any topic!). But don’t panic — this bug is not the apocalypse; we don’t have to hand the world over to the cockroaches just yet.
Well, you know, it’s very interesting. Since this book came out, where I argue don’t buy high-fructose corn syrup and don’t buy products with more than five ingredients, suddenly the industry is—you know, they’re so clever. I have to hand it to them. But now they’re arguing that their products are simpler, and there’s new Haagen-Dazs 5, which is a five-ingredient Haagen-Dazs product. You know, it’s still ice cream. Ice cream is wonderful, but we shouldn’t treat it as health food because it now has only five ingredients. … Frito-Lay potato chips now is arguing that they’re local. Now, you have to remember, any product is local somewhere. Right? This food doesn’t come from Mars. But to think that Frito-Lay as a local potato chip is really a stretch.
So, I’ve had to update my rules. And with all this new marketing based on these ideas, my new suggestion is, if you want to avoid all this, simply don’t buy any food you’ve ever seen advertised. Ninety-four percent of ad budgets for food go to processed food. I mean, the broccoli growers don’t have money for ad budgets. So the real food is not being advertised. And that’s really all you need to know.
There are a really startling number of “treadmill accident” videos on YouTube — some depicting true accidents, others deliberate setups. Why would anyone deliberately attempt to do a headstand on a moving treadmill? I dunno, but dude, that looks painful. That little safety thing you clip to yourself that stops the treadmill if you trip? Not just for decoration, folks!
In workshops I often use this comic when I talk about YouTube:
Anyway, the treadmill accident videos were mostly interesting because they led to some videos of construction workers doing highly inadvisable but clearly fun things with heavy equipment. Worth two minutes of your life, IMO.
(Not our cat. But likely representative of our cats’ potential reactions to the treadmill.)
It’s the limp, folded-over front paws and the back paws juuussst barely keeping up that really get me in this one. Bwah!
Mon May 11, 2009
Last week I did something to my back.
For the first couple of days, I could barely move without insanely excruciating pain shooting up my spine, stopping my breath and making me gasp. It reminded me of back labour, except it was even more painful. I was creeping around very gingerly, holding my lower back and making grumbly-gaspy old-lady noises whenever I had to stand up or sit down.
What did I do to myself? Well, the last time I did something similar (although much less severe) to my back, it was right before I went to Bermuda. The only possible similarity in the circumstances between then and last weekend: shaving my legs for the first time in months. I did nothing unusual other than that in either circumstance. So I am forced to conclude that I’ve been totally disabled by a shaving injury, and not even the exciting dramatic kind with spurts of blood and bandages and things. I don’t even get a good story out of it.
I have, in the past week, had a chance to experiment with and review pretty much all legal methods of pain relief, and so for public benefit and scientific interest here are my experiences with the many forms of back-pain analgesia. I measure pain terms of a typical pain scale from 0 (no pain) to 10 (excruciating, can’t think of anything else).
Aspirin: 1 point of pain reduction
Tylenol: 1 point of pain reduction
Ibuprofen (Advil): Zero. No pain reduction at all. Very disappointing and a bit surprising.
Naproxen (prescription): Zero. This really surprised me, since naproxen is usually good for physical/anti-inflammatory/muscle-y stuff — it’s great for arthritis.
AC&C (aspirin, caffeine, codeine): 2 points of pain reduction. My usual over-the-counter treatment for migraines wasn’t as useful here as I had expected.
Robacexet (Tylenol + methocarbamol): 3 points of pain reduction. Be sure to buy the coated version of any methocarbamol-containing product, because it is as bitter as quinine. Blech.
Robacexet (Aspirin + codeine + methocarbamol): 4 points of pain reduction. You have to ask the pharmacist for this stuff; it’s hidden behind the counter. Millions of thanks to Twitterer height8 for this tip.
A535 Dual-Action patches: 2 points of pain reduction. The patches really do last for four hours, and are less awkward than a hot water bottle stuffed down your pants if you need to be out and about. Plus you end up smelling kinda minty, which I’ll consider as a plus. And you can use this in combination with some sort of drug, so its 2 points of pain reduction are more useful than it initially appears.
A535 lotion: 1 point of pain reduction, and it doesn’t last long — maybe half an hour? Side note: it’s always bothered my scientific self that rubbing something on skin can do something useful for bone stuff like arthritis, but damn, the stuff does work for the arthritis in my hands for whatever reason (I’m sure it messes with how nerve endings interpret information or something), so I thought I’d give it a try for this too. Not really worth the bother in this case.
Hot water bottle: 3 points of pain reduction. How I love my hot water bottle, despite its annual dramatic structural failure and need to be replaced. However, there is only so much you can do that is productive while lying face-down with a hot-water bottle on your lower back.
2 glasses of red wine (an accidental discovery): 5 points of pain reduction.
Why? Why does red wine work well when normal drugs don’t, and when it doesn’t work at all for any other kind of pain? It is a mystery. Also, it’s deeply impractical — while two glasses of wine aren’t enough to be seriously impairing, they are enough to fog one’s brain a bit and they certainly aren’t the sort of pain solution you can deploy repeatedly throughout, say, one’s work day. At least not in my line of work (and I have lovely colleagues who, when they discover me lying flat on my back on a boardroom table to rest my back, skip the WTF? reactions and launch more-or-less directly into work-related conversations).
Anyway, one week later my back is feeling significantly better. Still, I’ve had a reminder about the immense respect I have for people who live with chronic pain — pain is one thing when you know or think it will be temporary, but quite another when it is likely to be long-term or permanent. It takes immense guts and determination to live a semi-normal life, to think through the fog that pain puts in your head, and to not be intensely crabby all the time. I bow to you all.
I’ve been doing my best to restrain my usual cynicism about the hysterical media coverage of health issues in the case of the swine flu, as until quite recently there have been too many unknowns to do much other than shrug and say “we’ll see”.
But it seems now that we do know some things:
1. It’s not terribly lethal, although (like the 1918 flu) it does seem to have a tendency to kill youngish, otherwise healthy people. I’ve seen death rate estimates up to 6% – which makes it several times more lethal than the 1918 flu, which had about a 2.5% mortality rate. That means that if you’re an excitable news type you get to say “200%+++ more lethal than the 1918 pandemic!!!!” because that makes it sound very dramatic indeed. But it also means, if you think about it, that even if you do catch it you stand 94 chances in 100 of recovering. Or to put it another way, a bit better than 15 chances in 16.
We should thank our collective lucky stars that if this genie is as out of the bottle as it seems to be, at least it’s a 6% — or less? It’s early days still, and the rural Mexican experience may not reflect the global experience, particularly that part of the global experience that has ready access to modern medicine — lethal genie with a 1-week incubation and not a 50-80% lethal genie with a disastrously long 3-week incubation like, say, Ebola.
Also, let’s remember that plain-Jane annual influenza strains are responsible for at least 700 deaths a year in Canada (possibly up to 2500). Not to sound callous, as every single preventable death is a horrible tragedy, but this flu may not even push us over normal numbers. (The potential difference which might not be reflected in the numbers, of course, is that we’re more used to influenza killing the very young and very old, not — as in this case — youngish adults.)(Like me.)
BoingBoing reposted this analysis of the 1918 numbers, which is useful in that it takes a sensible and calming approach. However, it also doesn’t tell us much that’s really applicable. Yes, we have good public health measures and near-instant communications now so perhaps less than 1918’s 28% of people would catch the thing. But on the other hand, we now have air travel which totally changes the game. It allows people to cross the globe well within the incubation period of the virus, and this sort of transmission has in fact already happened. No more do we have the leisurely plagues of old, which you could see coming across the world towards you for weeks or months before they arrived. I’d like to see some solid epidemiological modelling of air travel’s potential effects on this influenza virus’ transmission before I’ll be ready to agree we’re comparing apples to apples when we look at 1918. Anyway, it may be a reassuring piece to read.
2. Eating pork can’t give you the flu. Throwing out your pork products is entirely pointless. Enjoy your bacon, folks. It’s fine and it’s actually counterproductive to do otherwise and leave dead pigs moldering about. Better to clean up the pigs’ waste, which attracts flies which are (or seem to be) the actual swine-to-human disease vector in this case. The flies seem to be more of an issue than the pigs, and they are certainly more of an issue than processed pig flesh from the butcher. (If you eat or otherwise consort with flies that regularly feast on pig waste, you may wish to temporarily or permanently cease that practice.)(And look into therapy.)
3. It can be transmitted from one person to another. So the surgical masks are not necessarily pointless, depending on where you are in the world. I’m certainly comfortable taking the Toronto subway without one. In Mexico City, on the other hand, a mask is maybe not the worst idea, at least this week.
It ought to be pointed out that there are many kinds of “surgical masks”. I have not yet seen recommendations about which types are most appropriate for this purpose, so many of the people you see wearing those masks in pictures in the newspaper may not be doing as much as they think they are. Still, even the worst mask keeps you from touching your potentially icky fingers to your mouth and nose, so that’s something.
At this point, though, in Toronto I’d say just wash your hands after you get off the subway (which you probably do anyway). Or ride your bike.
4. It’s responsive to the more common antivirals in our current arsenal.
My conclusion: there’s no need to freak out just yet.
Yes, it’s making its way around the globe, and we can’t stop it.
Yes, it could easily mutate and become more deadly, although this is not generally a successful tactic for viruses; usually viruses become less lethal over time so its victims are better able to spread it. You can’t do much to spread your virus if you’re completely flattened by it, lying alone in your room.
Yes, the flu is a whole lot of no fun — someone online today used the expression “she felt she’d have to get better in order to die,” which well reflects my own experience with it.
Indications at this point seem to be that if you do catch it, the odds are heavily on your side, even more so if you are able to receive modern medical assistance in the form of antivirals and such.
So. You know. Keep calm and carry on, and never mind the excitable media.
But listen to the MOH and wash the heck out of your hands*. Think of it as an excuse to buy yourself some nice hand lotion.
* I’ll insert a corollary plea here: kindly do NOT use hand sanitizers unless you’re somewhere that totally lacks running water. Those things a) stink and b) are helping breed the superbug that WILL kill us all.
Children actually have an inbuilt self-protective sense that we destroy by over-cosseting. They become independent not so much by careful training but in part simply as a result of parental laziness. Last Sunday morning, Victoria and I lay in bed till half past 10 with hangovers. What a result! And the more often you do this, the better, because the children’s resourcefulness will improve, resulting in less nagging, less of that awful “Mum-eeeeeeeh” noise they make. They can play and they will play.
So lying in bed for as long as possible is not the act of an irresponsible parent. It is precisely the opposite: It is good to look after yourself, and it is good to teach the children to fend for themselves. Our offspring will be strong, bold, fearless, much in demand wherever they go! Capable, cheerful, happy. It is also the task of the idle parent to ensure as far as possible that all members of the family are enjoying themselves here and now, in the present moment. There is far too much emphasis on that imprisoning capitalist abstraction “the future.” There is no point in sacrificing pleasurable todays for the promise of more prosperous tomorrows. So stay in that bed as much as you can.
Wed Apr 15, 2009
She chose the red one over the white-and-pink one. I hold out hope that perhaps the pink phase might be nearing its end.
Of course, finding a bell that matched the bike’s frame colour was THE most important thing.
We spent some time practicing starts and stops at the school track. She had one swervy sort of crash in which she kind of forgot to steer while trying to shift and brake simultaneously, but she still managed to avoid hitting the major obstacles — Dad, wall, bench — and nothing got hurt but her pride. We dusted her off and reassured her yet again that everybody falls down sometimes and made her get right back on, and of course two minutes later she was just fine.
Zoom! And many thanks to all the grandparents whose birthday and Christmas generosity gave M such a nice present.
Once upon a time I tried to make apple cake from my grandmother’s verbal recipe: “It’s a sweet dough, with yeast and cardamom. Then apples and some sugar and flour on top.” Yeah.
My sister had the rather more practical idea of going over to Vanaema’s place and watching her make it. That sensible approach resulted in this excellent illustrated recipe, which involves kneading the dough by hand.
Since I had visiting parents who wouldn’t mind being guinea pigs, since we were making pasha anyway, and since we’d be visiting Vanaema it seemed like a good time to have a whole Estonian-dessert-making extravaganza and try making apple cake again too.
First attempt, I used my grandmother’s method. I suspect I killed the yeast with milk that was a bit too hot. The dough turned into a liquidy gloop which I poured down the drain. I’ll try it again sometime with milk of the appropriate temperature but it still seems like a lot of liquid (1/2 c water, 1 1/2 c milk, 3 eggs) for only 4 cups of flour. I’d be inclined to reduce the amount of milk by at least 1/2 a cup.
Still, the gloop smelled good, so I gave it another try. Second attempt, I cut the liquid and tossed everything in the bread machine on the dough setting.
Then we pressed out the dough and added the apples and topping as per the official recipe. Success!
On the left, my grandmother’s apple cake. On the right, mine.
The main difference is that hers has a rolled edge on the crust, a feature which means that when choosing pieces from a serving tray one must be virtuous and choose at least SOME pieces for one’s plate that are edge pieces instead of hogging all the best crust-free middle pieces. My aunt once whispered to me that it was possible to make apple cake without the rolled edge, so while doing so reduces one’s opportunities for public gastronomic virtue my helpers and I decided to take the crustless route.
I had also added a bit of cardamom, nutmeg and cinnamon to the topping mixture. My grandmother agreed it was good, but not correct. Hers, she says, isn’t totally correct either. My mother tried to open the door to innovation, but Vanaema was having none of it:
Mom: “But surely every Estonian mother makes it slightly different–”
Mom: “–puts her own touches on it–”
So this isn’t the Platonic-ideal-if-Plato-were-Estonian apple cake. I’m sure somewhere legions of Estonian grandmothers are deeply disapproving of the use of a bread machine for the dough (and the lack of the rolled crust edge, and the continued existence of Russia, and my failure to marry an Estonian, and and and.). But it is good.
Vanaema’s recipe, as recorded and illustrated by my sister.
My dough variation:
In a bread machine, combine:
1 tsp sugar
1/2 tsp salt
2 tsp (8g package) yeast
1 1/2 c milk
4 1/2 c flour
1/4 c butter (plus 1 tbsp)
1 tsp ground cardamom
Use the dough setting.
It’s a blurry little green thing! Actually growing!
There’s always such an unsatisfying lag between planting seeds and any obvious result. These lettuces were planted on Friday — five days ago — and already I was (quite unreasonably) getting all tappy-footed about it.
Now I just have to wait for the basil, lime basil, other lettuces, catnip, lavendar, petunias, nasturtiums, peppers and beans to appear… and then wait another month before the frost risk passes and they can go outside…