(I've written an explanation elsewhere of why disclaimers of this sort may be necessary.) 

Wednesday, September 30, 2009  

I had an unusually low-carb dinner last night -- and it was an early dinner, with no snacking afterwards. I guess that explains the low fasting result this morning. (See my comments from yesterday's post, about why I'm not too worried about getting fasting tests that seem to be slightly below the normal range.)

Tonight, just to make sure nothing strange is going on, I ate a dinner with more carbohydrate in it (at least 50 grams), and did a couple of post-prandial tests. I was at 117 after 1 hour, and 86 after two hours. Those are normal results. That is, they are within the normal range expected for someone who has not been diagnosed with diabetes. For someone who has, they are unexpectedly low, but not in a way that represents any kind of problem. Those are the kind of results you want to get, if you can. Right now I can, so I'm going to try to keep things the way they are for as long as I can get away with it.

Anyone who is diagnosed with diabetes is bound to have the same thought: what is my future going to be, now that this has happened?

There are many ways to imagine your future with diabetes; some of them occur to you spontaneously, and others will be suggested by others (such as advertisers for drug companies).

Immediately after diagnosis, your attempts to picture your future result in something like this:

It's all very gray and murky. It recedes into the mist, and although you don't know what lies hidden in that mist, you doubt that it's going to turn out to be something warm and beautiful.

Then the pharmaceutical industry tries to replace this vision with one that's more attractive. If you listen to them, and buy the right things from them, you will soon be able to leave your diabetes worries behind you, and enter a life that is all exuberance and sunshine:

The catch is that this exuberance, like most exuberance, only lasts until the drugs wear off.

An alternative vision is of the calmer, and hopefully more sustainable, joy of living in harmony with nature's way. If you can get enough fresh organic vegetables into your life, and otherwise make over your lifestyle to eject from it all modern habits, you can become one with the earth:

The only problem with this vision is the implication that you are going to become one with the earth by getting buried in it.

Then, if you keep trying to educate yourself about diabetes, you start to run into the "progressives" -- that is, the people who are strangely determined to convince you that diabetes is a progressive disease, and it always gets worse. They have seen what lies in store for you, and it's a very grim affair:

I'm not entirely sure what drives the progressives to play the grim reaper so insistently, but I have a nasty suspicion that they're thinking "Well, I lost control of my health, and I'm not going to be satisfied until you lose control of yours".

So what is my own mental image of my future with diabetes? I'm learning to see it as a well-tended vineyard:

Yes, it's autumn and the leaves aren't as green as they once were. But the vines are still going strong, and if proper care is taken of them, there will be another vintage next year, and for many years after that.

And maybe the best is yet to come. The oldest vines may not be as productive as the younger ones, but they make the best wine.

Tuesday, September 29, 2009  

Another low fasting result. I've had a lot of them over the last week or so. On Saturday, when I wasn't blogging, I had a fasting result of 69 (probably a slight under-reading by my meter, but not entirely insignificant). 

If I were taking insulin, or any medication that acts to reduce blood sugar, I might be warned that fasting results such as these are too low -- dangerously low. It's one of the many fringe benefits of controlling my blood sugar without meds that I don't have to worry about that kind of thing.

The body has defense mechanisms set up to protect you from going too low. Medications have to be used with caution because they can sometimes defeat those defense mechanisms (and maybe kill you as a result), but when you're just working with the body's natural responses to the food you take in and the exercise you do, that kind of thing isn't a concern. You can relax and let your body take care of the problem, so long as you know you've given your body what it needs to do the job.

I've had a few episodes of hypoglycemia, but only the kind of mild hypoglycemia that anyone can get -- the kind that makes you feel weak and shaky and hungry, not the kind that sends anyone to the emergency room. So long as I can stay off meds, I don't think it's something I'll have to worry about.

I suspect that some readers of this blog say to themselves "Oh, sure -- it's easy for him to keep his blood sugar under control!" whenever I post a picture of myself that looks anything like this:

So, maybe it's time I posted a picture of myself that shows you how I looked before I took up this diabetes-management thing. I have very few pictures from that period, as it happens (apparently I didn't like to pose for photographs then, for some reason) but I did find this one today:

It's not very explicit, but I think it gives you a rough idea.

This one doesn't even show me at my top weight (that came some months later). My firm recollection is that I got up to 250 pounds by the time I was diagnosed, although my doctor remembers it as 260. Well, either way, I lost a lot of weight afterwards. And most of it I lost early on. In 2003, two years after diagnosis, I looked like this:

Funny how the photographs taken of me since diagnosis usually capture me outdoors, engaged in hiking or running or cycling. The ones taken of me before diagnosis usually show me indoors, sitting around and not obviously engaged in doing anything in particular. 

As the saying goes, the past is another country.

Monday, September 28, 2009  

The heat wave is definitely over! It only got into the high 70s today, and in the evening it dropped below 50. This morning the ocean fog made its way nearly to the top of the 850-foot hill I live on. It should be cooler still tomorrow.

That's fine with me; it makes running easier.

Oooh, this is interesting. Poor Math Skills May Worsen Diabetes Control, says a headline in Diabetes Today.

Dr. Chandra Osborn and colleages at Vandervilt University in Nashville studied adults with Type 2 diabetes, and tested their ability to perform various number-related tasks (interpreting nutritional labels, calculating calories and carbs in a meal, etc). Their conclusion? Patients with the strongest test scores "generally" had better results on hemoglobin A1c tests. Because African-Americans tended to score worse on the numeracy test, the researchers saw this as a possible explanation for the trend toward poorer glycemic control in African-American patients.

This comes almost as a breath of fresh air after that Boston study last year, which blamed doctors for the racial disparity (on the assumption that doctors just don't try as hard when the patient isn't white). However, I'm not sure that this study really shows that math skills are at the heart of the problem.

Managing diabetes requires very little ability to calculate numbers. If you've been told to keep your A1c results under 7 and instead they're climbing above 9, you should be able to see that things are moving in the wrong direction without having to do any algebra first. Similarly, if one food provides 11 grams of carbohydrate per serving and another food provides 42, you don't need to solve any differential equations before it dawns on you that 42 is a lot more than 11. (If these numbers were sports scores, would you have trouble figuring out who was ahead?)

Maybe what's lacking is not an ability to calculate numbers, but rather a willingness to respect numbers.

If you've had occasion to counsel someone who is becoming diabetic but not becoming serious about it, you've surely seen that odd look in the eye that people get when they're revealing to you a test result, asking "That's not bad, is it?", and obviously waiting for you to assure them that it isn't bad, when they know perfectly well it is bad. You tell them what the normal range is, and then they mention a result that's substantially above the normal range... with that strange, hopeful, pleading look on their face that means "I've decided to pretend this number is unimportant; please tell me you think so too". But do you suppose those people would be just as indifferent to numbers if they discovered that a coworker less competent than thesmelves was getting paid 18% more? In that case, I imagine, numerical comparisons would suddenly seem to them both important and readily grasped.

Nobody needs much mathematical training to be able to figure out whether oatmeal has more starch in it than scrambled eggs, or whether a fasting test result of 145 is or isn't above 100. I think the real problem is not that people can't understand numbers, but rather that they pick and choose the occasions on which they are willing to take numbers seriously. If you're not willing to take them seriously in connection with diabetes (and with the personal behavior which impacts diabetes), then your experience of diabetes is not going to be pretty. But if that happens, it won't be because you can't remember the quadratic formula.

People who are in the habit of treating numbers as unimportant in most situations might very well do poorly on the math tests that were used in the Nashville study. But I think the real issue here is attitude, not skill at calculation.

Sunday, September 27, 2009  

The low fasting result this morning surprised me, as I'd gone to a party the night before (and, even more significantly, had taken a rest day from exercise). However, the party food I had indulged in was high-fat rather than high-carb. And I seem to be going through a phase of unusually low fasting tests. I know better by now than to assume it will continue indefinitely (I don't think I'm going to see anything like 74 tomorrow morning.)

I had been planning to do a trail-run today, but I was also planning to go to the Sebastopol Celtic Festival, and I wanted to get there in time for a performance that was starting at noon. Fitting in the trail run was a little difficult -- I needed time not only for the run itself, but also for transportation to and from the state park where I was going to be running, and also for cleaning up afterwards. I also needed time to eat (and digest) a substantial breakfast beforehand. After waking up with a fasting result of 74, I certainly wasn't going to go out into the woods by myself and run 7 miles without having eaten. And I certainly wasn't going to start running until I'd had a chance to digest what I'd eaten. So, I had a lot of time-consuming activity to get out of the way this morning. But I did it!

It was hot today (in the high 90s), and I knew I was going to be outdoors for most of the day, so I was careful to rehydrate myself after the run. Fortunately, there were a lot of awnings set up at the festival to provide shade, so even the outdoor perfromances could be attended in relative comfort. That is, the audience was comfortable; the performers (who hailed from such balmy regions as Scotland, Ireland, and Sweden) looked as if they were in danger of melting into puddles on the stage.

Today the festival organizers asked musicians representing different styles to play together in various combinations -- a little experiment in cross-fertilization. This kind of challenge is very difficult for musicians, and it certainly doesn't always work, but it worked today. Here's Mikael Marin (a Swedish viola player), Alasdair Fraser (a Scottish fiddler), Martin Hayes (an Irish fiddler) and Olov Johansson (a Swedish nyckelharpa player) finding common musical ground.

And here's the American cellist Natalie Haas (Alasdair's usual accompanist in Scottish music) playing with the Swedish guitarist Roger Tallroth.

No matter how good a musician you might be when you're operating within your comfort zone, the real test is how well you can keep functioning when you're well outside your comfort zone: playing unfamiliar music in an unfamiliar style, with little or no rehearsal. When you can handle that, you're a real musician. Well, these were real musicians.

Someone said that life is like playing a violin solo in public, but having to learn the instrument as you go along. Well, if life in general is like that, music-making is like that too!

Friday, September 25, 2009  

A reader has brought to my attention a fascinating new disease: orthorexia. As a Greek scholar might guess, orthorexia is an obsession with eating correctly. However, it's not about table manners, it's about making the right food choices. Sufferers from orthorexia are excessively preoccupied with identifying which foods are good for them, and which foods are not.

This isn't a joke, or at least not exactly. No doubt it is possible for someone who suffers from obsessive-compulsive disorder to become preoccupied with buying the right vegetables at the farmer's market instead of with hand-washing or adjusting picture-frames. On the other hand, it is very much a joke, and a familiar one, to anybody who knows the history of new psychiatric disorders and the experts who "discover" them.

The expert in this case is Dr. Steve Bratman, author of "Health Food Junkies", and a former proponent of health food who came to realize that he had a screw loose -- and dreamed up a name for his problem. He wasn't a bore who talked too much about kale, he was orthorexic. He suffered from a psychological obsession with food: "When I was involved with this, it took up way too much of my life experiences when there were other things I could have been doing."

Well, there are other things he could be doing now, too.

I think it is best to be skeptical of experts who "discover" a new psychological disorder which no one had noticed before. Often they have an agenda, and it often the agenda is not very well disguised.

One such disorder is (or rather was, since no one in his right mind would be tempted to take it seriously today) drapetomania. This malady was first described by an American physician named Samuel Cartwright, in a paper entitled "Report on the Diseases and Physical Peculiarities of the Negro Race", in the New Orleans Medical and Surgical Journal in 1851. The disorder is depicted in this painting by Eastman Johnson:

Yes, that's right: drapetomania was a disorder which afflicted slaves, and induced in them an unnatural impulse to run away from captivity.

Dr. Cartwright didn't merely identify this illness -- he also explained the cause of it (masters who were too familiar with their slaves, thus encouraging them to see themselves as equals) and suggested a means of preventing it (whipping).

Drapetomania is a particularly obvious case of rather ordinary human behavior being characterized as a disease because it helps somebody advance a social agenda. "Orthorexia" may well be more of the same.

People get obsessive about all kinds of things, but when one potential object of obsession is suddenly talked about as a terrible, epidemic problem, it's best to react cautiously -- and to ask why somebody wants us to see it as a terrible, epidemic problem.

My guess is that the number of people who worry too much about healthy eating is miniscule compared to the number of people who don't worry about it enough. Maybe somebody should invent a name for the latter problem. Is "pizzarexia" already taken?

Thursday, September 24, 2009  

I realize that a resting pulse of 42 sounds a little implausible, but I do sometimes get down that low. If I put on a heart monitor and lie in bed for a good long while, I typically get down to about 40. I guess, if you keep exercising long enough, things like that start to happen. Exercise gradually expands your cardiovascular capacity, so that your heart can move more blood per contraction. Because it no longer needs to contract as many times per minute to move the same amount of blood through your system, your heart slows down. Which is good, because I understand that lifespan is measured in heartbeats: you get only so many beats per lifetime, and people whose hearts beat faster use up their allotment sooner. (Well, actually, I think that rule applies mainly to comparisons between the lifespan of one animal species and another -- but I think there's some reason to think that it also applies when you're comparing people to people.)

Yesterday my left knee was sore after running. It didn't hurt when I was sitting, but it hurt a little when I walked around the office, and it hurt a lot when I was walking down stairs.

This morning it felt significantly better, but the pain was not gone, particularly when I used the stairs. So, at lunchtime, I faced the dilemma which athletes face so often: should I go ahead and run, or should I take a break from running and let the injury heal up?

To most people this sounds like an easy decision -- take a break! If you run with a sore knee you'll make it worse!

To me it's not so obvious. I have found in the past that resting to heal a minor injury does not always work out so well. Sometimes the body tightens up around an injury, and resting simply prolongs that problem. In many cases, the best way to speed the healing process is to use an injured limb, not to give it a rest.

Also: if I took a break every time some part of me was sore, my exercise program would be so frequently interrupted as to be useless. Eight days ago I had a sore ankle. Four days ago I had a sore hip. I continued to exercise despite these problems, and they disappeared almost immediately; who knows how long they might have lingered if I had declared an emergency and taken to my bed to recover? (I don't usually have this many problems, even minor ones, happening in such a short span of time; it just isn't my lucky month, I guess.) Anyway, if stopped exercising every time something hurt, I wouldn't be exercising enough to keep my blood sugar under control, and that's not an attractive option to me.

I realize that, if you have a serious injury, one which gives you a lot of pain while you're exercising, then the exercise is likely to do further harm and delay healing. But for minor aches and pains which you can work through safely, my experience has been that exercise is what cures the problem and rest is what prolongs it.

I decided that I would try to run at lunchtime, and see how it felt. If it was really bad, I'd abandon the run, and go to the gym in the evening for an easier workout.

Well, it turned out that running made my knee feel better almost immediately. And not just while I was running -- after the run, the knee continued to feel much better than it had in the morning. As a precaution, I took some Ibuprofen after the run, and wrapped an ice-bag around my knee for about 20 minutes while I was sitting at my desk. Either those measures worked or they were unnecessary; my knee continued to feel fine.

So I guess I won! 

Wednesday, September 23, 2009  

Good recovery on the fasting results so far this week, after my Monday result was up. 83 yesterday and 79 today. Here's the secret of my success: since the weekend I have been exercising hard and not going to any wedding receptions. Give this proven method a try; it might work for you, too!

Running today, I ran too fast down a steep hill to catch up with my running buddies (who had got ahead of me on the way up it), and afterwards my left knee started hurting. I don't feel it at all when I'm sitting, and I don't feel it much when I'm walking on level ground, but it hurts a lot going down a staircase. I hope I didn't cause myself a serious setback. I've got ice on it right now. If it's not feeling better tomorrow, I won't run -- I'll find a lower-impact workout to do at the gym.

These minor injuries are very big issues to people who are counting on exercise to keep them healthy. It's hard to run as much as I do and not get any running injuries. At least running is safer than basketball; there's a regular basketball game at work, and everyone I know who has participated in it has had injuries requiring medical treatment. Still, running is hard on the body as well. I try to be careful about it, but sometimes I get carried away.

The risk of heart attack has been found to be higher in people with certain anatomical features which seemingly ought to be irrelevant to cardiac health. The most famous example is a  crease in the earlobe: people who have that have been shown in several studies to have an elevated cardiac risk. Another example is a shortened ring-finger in men. Guys whose ring fingers are shorter than their index fingers tend to have more heart disease (and less testosterone, oddly enough) than men whose ring fingers are longer than their index fingers.

Nobody knows why short ring fingers in men, and creased earlobes in everyone, should have anything to do with heart attacks; researchers have noticed these connections but have not been able to explain them. Presumably these anatomical features result from certain gene-combinations which also, quite coincidentally, increase the risk of heart disease in some way. Maybe we'll find out how this works some day; maybe we won't.

Keeping all that in mind, what would you think if cosmetic surgeons starting offering to smooth out your earlobe creases, or alter the comparative lengths of your index and ring fingers, as a means of preventing heart attacks? Wouldn't you be inclined to think that Drs. Nip and Tuck were getting things a little bit backwards here?

So far as we know, the shape of your ears and hands does nothing at all to your heart, and your heart does nothing to the shape of your ears and hands. The shape of your ears and and hands just happens to be a visible marker of certain DNA sequences which just happen to affect your cardiac health as well. Cosmetic surgery isn't going to change those DNA sequences, so there isn't anything a surgeon can do to your ears or your hands that will reduce your cardiac risk.

Now that we've got that silly and obviously hypothetical example out of the way, what would you think if your doctor offered to give you drugs to eliminate certain other markers associated with heart disease, even though the evidence doesn't seem to show that eliminating those markers is effective at preventing heart attacks? You see, I'm no longer talking about silly, hypothetical treatments. The treatments I'm talking about may be silly, but they're very real and are prescribed for millions of people.

Abnormal results on a test of cholesterol in the bloodstream are certainly associated with elevated cardiac risk, and people who improve those numbers by changing their lifestyle (mainly by exercising more and eating less) do bring that risk down. This doesn't mean that any method of bringing your cholesterol down brings your risk down. Most of the people who take Lipitor and other statin drugs, to reduce their cholesterol through chemical intervention rather than healthy living, don't bring down their cardiac risk significantly. (There are exceptions: people who have already had heart attacks can reduce the risk of recurrence by taking statins. But people who take statins to avoid having their first heart attack are likely to be disappointed.)

In short, a lot of people are being given a chemical treatment which is supposed to prevent heart attacks but is actually about as effective on them as earlobe-surgery would be.

Oral diabetes drugs are in many ways a similar story. They do bring down blood sugar levels, and that's good, at least in terms of preventing those complications (such as retinopathy and neuropathy) that are more or less directly caused by high blood sugar. But the big heatlh issue with diabetes is the high risk of a cardiovascular "accident". People with diabetes have more than double the usual risk of heart attack and stroke; according to the American Heart Association, 75% of diabetics die from those causes. And one study after another has found that getting your blood sugar under control through chemical intervention does not eliminate, or even significantly reduce, the cardiovascular risk associated with diabetes.

Diabetes drugs help prevent a lot of problems, but they don't give you any help with the biggest problem you face. If you would like to avoid having a heart attack, don't look to metformin for help. Heart attack prevention is a do-it-yourself job.

Here's an example of what I'm talking about, from Reuters and the Journal of the American Medical Association, September 16, 2009:

Diabetes Drugs Alone Do Not Ease Key Heart Risk

Drugs used to control diabetes do not reduce signs of inflammation that are linked with heart disease, U.S. researchers said on Tuesday in a study that reinforces the need for diet and exercise.

Both heart disease and diabetes are inflammatory diseases, and researchers had assumed that controlling diabetes would have an effect. "At the time we initiated the trial, we were thinking if we treat the diabetes, we will lower inflammation," said Dr. Aruna Pradhan of Brigham and Women's Hospital and Harvard Medical School in Boston, whose study appears in the Journal of the American Medical Association.

"This study suggests that lowering glucose alone does not impact one important risk factor for heart disease, and that is inflammation," Pradhan said in a telephone interview. She said the data may help explain the findings of a number of large studies in diabetics that found aggressive control of blood glucose did little to protect against heart attacks and stroke. "Just simply treating diabetes does not seem to have a benefit at preventing these vascular events," she said.

Pradhan said her study confirms the need for diabetics to exercise and have a healthy diet and weight.

The reason I'm harping on this is that I know a lot of people with diabetes assume that they get to make a choice between adopting healthy habits and taking meds. If you don't get your blood sugar under control by working out and adopting better eating habits, then you can forget all about exercise and diet and just start taking the pills instead.

But it doesn't work that way!

In more or less unrelated news, a fellow named Stephen Von Worley has created a map of "The Contiguous United States Visualized by distance to the nearest McDonald's":

The 13,000 or so McDonald's restaurants on the map are shown as bright dots. The dark patches in the western half of the country (in Nevada, Idaho, Oregon, and South Dakota) are the few places in the lower 48 where it's a long drive between McDonald's restaurants. The farthest you can get from the golden arches is a remote spot which lies between the tiny towns of Meadow and Glad Valley, South Dakota. That location is 107 miles from the nearest McDonald's (as the crow flies -- it's farther if you drive).

I'm sure this proves something or other, but I'm not sure what.

Tuesday, September 22, 2009  

Well, it was a warm day. It got up to 95 degrees by 2 PM. However, it wasn't that bad when I went running at lunchtime. I didn't even carry water (although I would have if the run had been any longer). 

I was with the fastest of my running buddies, and I kept up with him most of the way. I only fell a little bit behind him on the steepest climbs, and I caught up later. This was mostly because he's still dealing with a cough, and wasn't up to his usual speed, but I think I was at least a little faster than usual.

After work I went to a local pub to hear their musical guests for the evening -- a selection of four of the women accordion-players who are featured in the just-released Accordion Babes Pinup Calendar for 2010. The Accordion Babe at the upper right (Miss June to you) is a musician friend of mine, and she was playing with other musician friends of mine (a fiddler and bass player) so I went to hear them. Accoustically speaking it wasn't the best possible setting for music-making, but it was fun.

I don't know if there's a Fiddle Studs 2010 calendar, but if there is I haven't been invited to pose for it. Well, there's always 2011. It's good to walk into the gym with a goal in mind!

Monday, September 21, 2009  

Well, 94 is not a great fasting result, especially considering how well I was doing last week, but it follows a weekend of party food (including a wedding reception), so I think it's not bad considering. I expect to start doing better now that the weekend is over.

A heat wave was expected today, and we went running earlier than usual to get it done before the mercury rose too much. But the mercury never did rise as much as expected (it barely got to 90, and that was well after the run was over). Now it looks as if the heat wave is going to arrive tomorrow -- which is too bad, because my meeting schedule tomorrow will not allow me to go running early. I'll have to run at noon and make the best of it. 

A couple of weekends ago, when I was hiking at Point Reyes with some musician friends, we played a few fiddle tunes in the evening after our picnic dinner, and this attracted the attention of Christine Krieg, a professional photographer from San Francisco who happened to be there. She took a lot of pictures of us and promised to make them available to us on-line. Today she came through. I thought she got a lot of good shots, especially considering how dim the light was getting at the time.

But you know what they say: the camera adds five pounds and six wrong notes. I don't know why I look so much taller than them in the next shot, but it has to be an illusion -- I think we were on uneven ground and I was standing on a bump.

I think if I were a movie actor they would have to put some pretty heavy makeup on me. However, as I'm already 52 and nobody has asked me to do a screen-test yet, I probably don't need to worry about it.

Photographers need to keep their senses constantly alive to the possibility of seeing something picturesque and unusual, wherever they go. They may drive up to Point Reyes to take pictures of scenery and hikers, but if a group of fiddlers turns up unexpectedly there, they are certainly going to seize the opportunity.

It's not just photographers who need to do this, of course. Artists in general tend to go through their day trying to be ready to notice, and possibly make use of, everything that happens around them. Henry James said that a writer is one on whom nothing is lost. All artists live by this principle. A songwriting workshop I attended at Lark Camp included, as one of the class assignments, writing down 10 overheard remarks and choosing one of them as the inspiration for a song.

But is it only the artists who need to do this? Maybe the rest of us also need to be more aware of what's happening around us, and what it might mean to us. Or, to put it another way, maybe we need to stop tuning things out.

Tuning out whatever is happening around us (and also, every often, what is happening within us) is a modern defense-mechanism which seems to do a lot more harm than good.

I was reminded of that issue during my yoga class tonight. A lot of what goes on in yoga is intended to get you to pay more attention to what is going on inside you. After doing a series of forward-bend poses with our heads down, my teacher had as stand up very straight and very still, and said "Observe the body... observe the mind... observe the breath", and however silly that may sound at first, there's a point to it. How much attention do we usually give to the body, the mind, the breath? Very little, I would say. We're out of touch with ourselves.

I see Type 2 diabetes as an especially severe case of being out of touch with yourself. The "denial" that makes it so easy for us to over-eat and under-exercise is largely a matter of losing touch with the body and mind, switching over to automatic pilot, and failing to perceive any of the signals that the body can use to tell us that the habits we're adopting are not healthy ones. The warning signals are all there, but we've disconnected the alarm bell, so how would we know?

Friday, September 18, 2009  

I've been wondering about a pair of words that come up amazingly often in discussions of diabetes. Those words are denial and motivation. It seems that hardly anyone can manage to tell his story on the dLife forum wihtout using one of those words, if not both. Everybody is in denial, and lacks motivation, or so it seems. Here's a sampling:

Comments like those, when posted on a diabetes forum, nearly always get a response on the lines of "It's perfectly normal to feel that way! Everyone with diabetes has been there!".

But I haven't been there, at least with regard to diabetes management, so all this talk makes me feel like a man from Mars, trying to figure out the puzzling ways of the earthlings and not quite succeeding.

Denial has an interesting history. The term, as we use it today, was formulated by Sigmund Freud -- that great fountainhead of self-serving balderdash. According to Freud, denial is a defense mechanism, in which a person who is faced with an uncomfortable fact convinces himself that it is not true, despite any amount of evidence.

The term was useful to Freud primarily as a club with which to beat down patients who disagreed with his analysis of their feelings. When a patient rejected the meaning Freud read into a dream, this wasn't a difference of opinion, it was denial -- a case of a patient's being temporarily unable to recognize that Freud was always right.

Despite its dubious origins, the concept of denial lives on and is taken seriously today -- usually in connection with the psychology of addiction. Well, maybe it's a real phenomenon in some sense, but I can't help taking a skeptical view of it. To me, explaining that you're in denial sounds suspiciously like explaining that you're asleep -- the claim seems to be self-refuting. If you're capable of arguing that you are asleep, you must be awake. If you're capable of arguing that you're in denial, you must be more fully aware of the situation than you're letting on. How would a person who really was in denial know that he was in denial? I guess what bothers me about the word is that I think people use it too much as an excuse. "I couldn't help myself -- I was in denial! I didn't know any better!"

I guess the compromise I would propose with people who use the word denial is that they are free to use the word so long as they sign a statement which stipulates that "denial" means "a conscious decision to pretend that something is not true, when in fact you understand perfectly well that it is true".

And what of motivation? The word has multiple definitions; the two which seem relevant here are "an incentive or reason to do something" and "willingness of action". The former seems to me the more commonly intended meaning in ordinary conversation, but it can hardly be the meaning that the people on the dLife forum intend. They complain that they lack motivation, and it's hard to see how anyone with diabetes can claim to lack an "incentive or reason" to manage the condition so that they don't sicken and die. As motivations go, "not dying" is one of the very best -- recognized by every authority from Charles Darwin to Al Capone.

Therefore, I assume that where these people are coming up short is in the willingness-of-action department -- but I'm unable to follow them there in my imagination. Nobody knows better than I do what it's like to feel reluctant to exercise, but as soon as it became evident to me that my survival depended on it, I accepted that it was something I needed to do, and would do. I can't say I enjoyed it a lot at first, but I very quickly got past the point of thinking that it mattered whether I enjoyed it or not.

I'm not claiming that, because I think differently from other people about diabetes management, I'm a better person than they are. I'm probably more irrational than they are about certain other subjects; diabetes just doesn't happen to be the area of life in which I'm screwy. But shouldn't people try to confine their screwiness to subjects which aren't matters of life and death?

All this chatter about denial and motivation worries me because I think people are using it to legitimize screwiness, in the one area where we can least afford to be screwy. I mean, be as screwy as you like about your job or your relatives or your politics, but when it comes to diabetes management, for heaven's sake, please try to stay clear-eyed and realistic. Trust me: your cadiovascular system doesn't care what you have decided to pretend isn't going on in there, and your muscles don't care how uninterested you are in using them.

Thursday, September 17, 2009  

Blood sugar down, weight up! Am I the only one who finds that those two usually move in opposite directions?

At least my blood pressure is still good. I don't often get two low readings like that, two days in a row.

When you report good test results, as I did regarding my annual physical on September 14, are you inspiring other people, or making them feel bad?  So far I've only heard from people who felt inspired by what I reported, but I always wonder if there's someone out there thinking "It's not fair! I'm doing the same things he's doing, and I'm not getting the same results!".

The trouble with defining Type 2 diabetes as a "lifestyle" disease is that it creates the impression that anyone who has it must have been asking for it -- and that, if they aren't able to get it under good control, they just aren't trying.

In some cases, it isn't possible to get your blood sugar under control just by losing weight and exercising. And you don't know, before you try to do that, whether it is impossible in your case or not. This makes it hard for people to keep trying when the going gets tough. What if they're wasting their time, trying to do something which can't be done?

My counter-argument is that they won't be wasting their time, regardless of whether they are able to work their blood sugar down to the normal range or not. Weight loss and exercise will help them avoid the cardiovascular problems associated with diabetes -- problems which are not automatically elminated when you get your blood sugar under control. The fact that weight loss and exercise are not always enough doesn't mean they're not necessary. People shouldn't be too quick to say that they tried exercise and it "didn't work". Maybe you tried exercise and it didn't move your fasting level below 100, but that doesn't mean it didn't benefit you at all.

Wednesday, September 16, 2009  

Yesterday was a busy day for me, and I just couldn't spare the time to do a blog post. Anyway, after the good news I received from my doctor on Monday, I felt entitled to take a break. A break from blogging, that is -- I did go for a run.

I didn't want to risk running today, however, because my right ankle was feeling sore. I assume this was the result of a minor mishap last night, when I was changing a light bulb in the ceiling fixture in the bathroom. Getting down from the step-ladder, I caught my foot on the edge of the bathtub, and slid on it. My ankle doesn't really feel all that bad -- I can walk around well enough -- but I figured running would put too much strain on it, and make it worse.

So, I planned on going to the gym after work. Then I got home and found that I had an e-mail from the gym, with the alarming subject line "No Hot Water, Again!!!" A water-heater problem at the health club had occurred recently, and seemingly had been solved. Today's message read "Unfortunately, when the new part was installed and everything working perfectly, the igniter quit operating! So now, we have agin ordered the part but have been told that it will not be in until Friday!" As I am not a cold-shower kind of guy, I decided to go to the gym already dressed in my workout clothes, and come home in them to take a shower in my own bathroom (with its excellent lighting!). I was on my way to play Irish music with some friends later in the evening, so having to make that trip back and forth just to get a shower in did not make things any easier. But I did manage to get my wokout done, and get to the jam session on time. Exercise is easy -- finding room for it in your schedule is hard!

Now I'd better get to bed -- I have an early morning phone-meeting with someone in Scotland tomorrow, and I don't want to oversleep and miss it. 

Monday, September 14, 2009  

Today was the big day -- my annual physical, which always makes me nervous because I know that my doctor is going to show me my lab results, and I'm always afraid it's going to turn out I'm not doing as well as I thought. Well, that didn't happen; all the critical tests showed improvement since the last time they were done.

Test This Time Last Time
Hemoglobin A1c 5.3 5.4
Fasting Glucose 81 89
Total Cholesterol 141 162
LDL 76 96
VLDL 11 14
HDL 54 52
Triglycerides 57 72

 "Last Time" means last year, for every test except the first: I haven't had a Hemoglobin A1c test since 2006. (I'd been getting normal results on them, so for a while my doctor stopped ordering them.) I'm not sure it is valid to compare my current A1c test to the last one, because the 2006 test was done using a different measurement standard, and for that the normal range was defined as 4.5 to 5.7. For the current A1c test method, the normal range is higher (4.8 to 5.9). At any rate, my current A1c result is in the middle of the normal range for the test as it's done now, and the result is also a point lower than it was last time. So, either way you look at it, it's good news on the A1c front. 

Fasting glucose measured 81. That result agrees very well with my own meter (which measured 79 about 15 minutes before the test). I had been worrying about the accuracy of my meter; apparently it's doing a pretty good job.

Lipids are substantially better than last year. Triglycerides and bad cholesterol are down significantly. Good cholsterol (HDL) is up a couple of points, and at 54 it's excellent for someone who is carrying the genes for Type 2. Most people with Type 2 can't get their HDL above 35. I couldn't either, for the first year or so after diagnosis, but since then my HDL has been climbing, slowly but surely. My doctor said I've totally eliminated lipids as a risk factor for heart disease.

On the doctor's office scale my weight measured 178, which is 12 pounds less than last year. Amazingly, my blood pressure measured normal in the doctor's office. That has only happened to me once before, and it was about 3 years ago. I think it helped a lot that I did a hard, hilly run not long before the doctor's appointment. My blood pressure usually drops after a good workout. The one time I got a normal blood-pressure reading in the doctor's office before, I had traveled to the appointment by bicycle.

Okay, now that it turns out my results are better rather than worse this year, what does it all mean?

One thing it means is that your health doesn't have to go into a tailspin after you are diagnosed with Type 2 diabetes. At this point I'm eight-and-a-half years past diagnosis, and without any help from pharmaceuticals I'm able to achieve normal test results for lipids, blood pressure, fasting glucose, and hemoglobin A1c. If they lost my medical records they wouldn't be able to tell that I had ever had problems with any of those things, though in fact I used to have problems with all of them.

What made this possible? I think that the success I've enjoyed owes more to regular, challenging exercise than to anything else. If you ask me, exercise is the big issue in managing Type 2 diabetes, or at least in managing my Type 2 diabetes. Most people assume diet is the big issue, but I think that's secondary, except in terms of weight loss (and I think weight loss is mainly about eating less food rather than choosing particular foods). I've found by experiment that some diets work better for me than others, in terms of glycemic control, but what kind of meals I'm having never seems to make as big a difference to my results as what kind of workouts I'm having. Probably that wouldn't be true for everybody, but it seems to be true for me, so I'm staying focused on exercise as my top priority.

It's impossible to know how long I will be able to continue succeeding with my current approach. Some would be inclined to point out that I'm only delaying the inevitable. Well, that's the only thing that any kind of health regimen can aim for: delaying the inevitable. I don't think immortality is one of the options on the table. If you hang around long enough, you will eventually sicken and die. You don't really get a choice about that; what you get some choice about is how long you get to enjoy good health before that happens. I'm just trying my best to maximize the good-health phase of my life. So far, so good...

Saturday, September 12, 2009  

When I was awakened at 4:30 this morning by a thunderstorm (not a commonplace phenomenon in this area), I thought that maybe my plans for the day might have to be altered. I was supposed to attend an outdoor party at noon. When I finally got up, it was raining. I checked the weather forecast, which predicted showers on and off throughout the day.

However, the weather that we actually got looked like this:

My party hosts (who live in a very pretty rural neighborhood) set up canopies in their back yard, next to their impressive vegetable garden, to protect us from the rain. No rain fell, but we needed the canopies to protect us from the sun.

Most of the guests were strangers to me, but I didn't have to strain my small-talk muscles too much, because some of the guests were musicians, and we had a nice jam session.

Some of the musician guests were specialists in French folk music, which I'm pretty unfamiliar with -- but it's very easy music to pick up by ear, so I didn't have much trouble joining in. The odd-looking instrument that the woman is playing is a hurdy-gurdy.

Comfortable as the weather was, reminders were everywhere that summer was over. For example, the dried-out remains of this giant sunflower...

...and these ripe apples littering the ground in the orchard around the house.

As happens to me so often, my rest day coincided with a party. I don't think I overindulged all that much today, but the combination of party food and no exercise is never favorable, and it's likely to be reflected in my fasting test result tomorrow. Well, I'll do a good long run in the morning to make up for it.

Friday, September 11, 2009  

A little warm for running today -- 90 degrees -- but we didn't let that stop us, did we? No! My running buddies and I are way too tough to be stopped by anything as trifling as hot weather.

We did let it discourage us from tacking an extra mile onto the end of our route, though. No need to get carried away, after all. Nothing in excess, that's our motto!

The odd thing about running in the heat -- at least the kind of low-humidity heat we have in Sonoma County -- is that I only find it hard during the early part of the run. I wear microfiber "wicking" shirts when I run, and once they're good and wet they start to provide a pretty good cooling effect. Plus, I get used to the heat as the run progresses.

It's when the run is over that the heat suddenly gets to me. Once, when I was training for a marathon, I did the longest of the training runs (20 miles) on a hot day, and I was fine until I finished, but then the heat suddenly got to me all at once; I immediately became dizzy and ill, had to sit down, and was on the edge of passing out for about five minutes. I don't understand this phenomenon, which has happened to me repeatedly. A possibly related phenomenon happens to me during the peak of my spring allergy season: I'm fine when I go outside, but when I come back indoors my eyes and nose suddenly start reacting to all the pollen they collected while I was outdoors. I don't get it, but that's what happens. I suppose this is not a mystery which researchers are spending a lot of time trying to solve.

I should acknowledge that the demonic-looking image of a loaf of bread with a knife in its teeth, which I used in my September 10 blog entry to illustrate my comments about baked goods, was not my work. The thing is, I don't know whose work it is! Whoever the food-sculptor was did a good job, particularly on the teeth. The picture was one of a series of funny food-images sent to me (without identifying information) by someone who was just forwarding what had been forwarded to him. I've also seen the same images on other websites, but the artist who created the scultures is never named. Maybe the sculptor will send me an angry e-mail now.

In recent years I've made it a rule to do some kind of organized, public athletic event (usually a footrace) every month. It has just dawned on me that I didn't do anything of the sort in August. I think my last such event was the Kenwood Footrace in July. On the Fourth of July, to be exact, so it's been more than 2 months now! I should do something about this. I realize that exercise is exercise, whether you're doing it with a thousand other people in a community event or by yourself, but it seems to me that big, exciting, public events are an important ingredient in anybody's exercise program. We need the social reinforcement that comes with that.

I have events planned for October and November, but so far nothing for September. Scanning the usual websites to look for upcoming opportunities, I find a surprising scarcity to events in September. The two likeliest prospects are a trail run on Angel Island (September 26) and a 10K run in Petaluma (September 27). I'm inclined to favor the Petaluma run, because it's a lot closer. And cheaper. We're allowed to take that factor into account during a recession.

Thursday, September 10, 2009  

I have an appointment with my doctor on Monday (just my annual physical). Early this morning I went in to the Labcorp office to get blood drawn for the lab work, so that my doctor will have the results in time to discuss them with me. There's always a bunch of other patients in there first thing in the morning, on their way to work (or on their way to breakfast) and eager to get the tests taken care of so that they can get out of there and eat something, after fasting for 12 hours. But the office was understaffed today; there was only one employee there collecting the blood samples, so everyone had more of a wait than they had counted on.

There really is nothing like a long wait in a medical-office waiting room to make you judge your fellow man, and judge him harshly. Most of the other people in that room were the people I am most afraid of becoming. Seeing them scared me, but also made it a little easier for me to get myself to the gym today, so in the overall scheme of things I guess they did me a favor. I am more determined than ever not to end up like those people, and I wouldn't have that determination if they weren't around to set a bad example for me.

I might end up like them anyway, no matter what I do, but that doesn't mean I shouldn't try my best to avoid it. And if my legs ever end up looking like that, I won't leave the house wearing shorts and sandals -- that much, at least, I can promise!

Unanswerable question of the day: is bread truly the enemy?

I have resisted the very-low-carb approach to diabetes management, preferring to reduce carbs no more than I must to maintain blood sugar control. Certainly my carb intake is lower than that of most non-diabetic people, but a lot of people with diabetes cut back quite drastically on grains, and so far I haven't done that. I still eat bread. I just don't eat as much of it as I would like to.

I don't have a very thorough rationale for this approach. Maybe it boils down to this: I like bread a lot, and I'm usually able to get away with eating it, so I haven't felt the need to demonize the stuff. I can take meat or leave it, but baked goods are another story for me. For a lot of people it's the other way around. I suspect that our willingness to adopt a particular diet is often based on little more than an awareness of what kind of food we wouldn't mind giving up. If bread isn't important to you and meat is, the Atkins diet is going to appeal to you a lot more than a vegan diet would. You may convince yourself that your personal tastes are not influencing your decision-making here, but I doubt it! I know that my own fondness for bread is making me look for reasons to be skeptical of the low-carb approach, just as a fondness for cheeseburgers is making some people look for reasons to be skeptical of the low-fat approach.

There is no such thing as objectivity where food is concerned! 

Wednesday, September 9, 2009  

We all run dry once in a while, and I find that I have nothing to say about diabetes this evening. So here's what is running through my mind, when I ought to be thinking about more important things...

I just noticed today's unusual numerical date: 09/09/09. We hasn't anybody started an apocalypse scare based on that? Maybe they did; I don't always pay a lot of attention to apocalypse scares, so one could easily have slipped by me.

September 9th had another odd numerical significance 28 years back: it was Square Root Day in 1981 (09/09/81). Of course, we've had other Square Root Days more recently (02/02/04, and even 03/03/09 earlier this year). For some reason I like to notice this sort of thing, but that's as far as I carry it. I don't jump to the conclusion that every numerical oddity has a profound significance, or that an unusual number appearing on the calendar means the world is coming to an end.

Some would see signs of the apocalypse in the mere fact that you can now buy a plastic carrying case for your banana:

Well, I say thank heaven that gap has finally been filled. And in four colors, yet! (If "clear" counts as a color.) I don't have nearly enough plastic products lying around in my house, so it's always good news when a new one becomes available.

Still more signs of the apocalypse: the pictures from This Is Why You're Fat continue to amaze. Here's a partial peak inside a "sandwich" known as the Big Fat Ugly, a product of the Fat Sandwich Company, which has restaurants in Oklahoma, Illinois, and Wisconsin:

The Big Fat Ugly (for which there is no charge if you can manage to eat it in 15 minutes) contains, among other things, four cheeseburgers, a double cheesesteak, a chicken cheesesteak, gyro meat, grilled chicken, bacon, sausage, mozzarella sticks, chicken nuggets, pizza bites... I think I'd better stop there, even though the inventors of this treat did not.

Well, maybe the above does have some little bit of relevance to diabetes. But I hope I'll be able to think of something more useful tomorrow.

Tuesday, September 8, 2009  

My running buddies were both unavailable at lunchtime, so I figured if I was going to be running alone anyway, I might as well do the sort of run I really like. So, I waited until after work, went to the state park, and did a trail run. This month it's getting harder to squeeze in a long run before sunset, of course, but I did manage to finish while there was still some daylight left. I might as well take advantage of the opportunity before it's gone.

I got a nice surprise -- I actually felt good during the run. (I'd had my doubts before I started -- I wasn't feeling especially strong.) Even the steepest climbs weren't that hard on me. I liked being there. The temperature was just right -- warm at the start, and gradually cooling. The woods and meadows looked beautiful in the late-afternoon light.

I assume that this run is the reason for my low blood pressure tonight. It's a temporary effect, but a temporary advantage is better than none.

My low fasting test today probably occurred because yesterday I combined a solid run in the evening with a light dinner. I did the same tonight -- we'll see if it works twice.

Here's a cartoon that says a mouthful, by Zach Weiner:

Monday, September 7, 2009  

Yesterday was a rest day. Today wasn't, and I had a rather low-carb dinner, so I hope tomorrow's fasting test will be lower.

Writing this blog, among other things, has really been getting in the way of practice time for music lately. So, I made a decision to focus on music as much as I could this holiday weekend -- both practicing at home, and playing with friends.

Some musicians I met at Lark Camp last month suggested going to a concert in Marin on Saturday night, and as it was very near Point Reyes, we decided to start the day early with a hike at the Point Reyes National Seashore. The title "National Seashore" implies that there isn't anything to it but a strip of beach; actually the park extends well inland, and there are woods and steep hills to hike. 

It was sunny in the morning, but the ocean fog was already spilling over the hills by the time we started our hike.

Taking the Mt. Wittenberg trail up to the top would have been disappointing, as the panoramic view of the coast you can get from up there on a clear day would be absent. Instead of doing that, we just took the Bear Valley trail out to the coast. That trail is not especially hilly, so I told myself that it wouldn't count as a workout, and I should declare Saturday my rest day and do a workout on Sunday. But the trip to the coast and back turned out to be a little over 8 miles, which I don't think is terribly long for a run but it's a very long way to walk. By the time we finished the hike, I told myself that it did, too, count as a workout.

At the time we reached the coast, the fog was thinning out a bit. You could see the landscape within a mile or so; it just looked indistinct. It's an effect I rather like, actually.

The sea seems a little ghostly when it fades into the mist like that, with no horizon to be seen.

Everyone wanted to get up onto this cliff to look out at the invisible sea.

Actually, what they wanted was to perch very close to the edge, so that their friends could take scary pictures of them. 

Although you couldn't see much of the ocean, as the fog came and went you occasionally got pretty clear views of the coast.

As this big rock off the coast faded in and out of visibility, I wondered how many sailing ships had smashed into it in the fog in the old days.

We eventually did make it back to our starting point in time to have a picnic dinner, and even to get out our instruments and have a little jam session at sunset before we had to leave to get to the concert. A woman with a serious-looking camera came by and started taking pictures of us as we played; it turns out she's a professional photographer. We exchanged e-mail addresses, and she said she would make the pictures available to us later. Maybe there will be a shot of me playing with my eyes open -- I do play that way sometimes, but not many photographers have captured the phenomenon.

On Sunday I played at another session (at Murphy's Pub in Sonoma), and did a lot of practicing at home. I practiced even more at home today. I sort of feel caught up on music now. I think I'm ready to get back into the world of working in the daytime and blogging at night, but I'm determined to carve out more time for music practice than I have been doing lately. Of all the bad health-habits you can fall into, the habit of not making music is among the very worst. It drags everything else down. Avoid it if you possibly can!

Friday, September 4, 2009  

In the September 2nd entry in his diabetes blog, Bob Fenton issued a challenge to diabetes bloggers to find a way to write so that they can express their feelings without being overly negative and obscene. For him, even writing that makes a good point is not valuable if the tone is so unpleasant that he doesn't want to read it.

I suspect that his reaction to ranting diabetes-bloggers is a little like my reaction to the movie "District 9", which I saw last weekend. I saw it at a matinee, and about an hour into the film, here's what was going through my head: "Even though many aspects of this are cleverly done, the bottom line for me is that this film is loud and gross and unpleasant. Also, it doesn't make sense, and there's no way the director can distract me from that fact, no matter how many things he blows up. And meanwhile, it's a nice, sunny afternoon outside, so why am I indoors watching a film that's loud and gross and unpleasant and doesn't make sense, instead of outdoors taking a walk?"

The thing is, the movie seemed to be trying to make some serious points about politics and race-relations, but I wasn't in a mood to appreciate those points. I was being subjected to loud bangs and sprays of blood. That doesn't tend to get me into the mood to listen thoughtfully to somebody else's ideas about how the world works.

Angry writing about diabetes is, I suppose, another version of the same thing. However heartfelt it may be, the reader's reaction is likely to be: "All right, all right, I get it: you're angry. Now run along and spoil somebody else's day, while I go outside for a nice walk."

I don't really understand the diabetes/anger thing, anyway. When people with diabetes talk about being angry, I always wonder who they're angry at. Do they really think somebody deliberately gave them diabetes? If so, who did it? And how? And why? Or do they feel cheated, because they had been assuming that life is set up so that health problems only happen to bad people who have it coming? (That's a pretty nasty way to think about disease, by the way, and I'd say anyone who does think that everyone else deserves the diseases they get, deserves to get a disease. But it won't happen that way: people don't get sick because they deserve to, they get sick because they get sick.)

I have been assured that it's the natural, human reaction to any diagnosis of a chronic disease to flail around moaning "Why me? It's not fair!". (I didn't react that way, but I'm not natural or human.) Well, if everyone else reacts that way, then everyone diagnosed with diabetes is entitled to a period during which he oscillates between righteous fury and morbid self-pity. However, that period has got to have a time-limit imposed on it. I would set the limit at 7 days, tops. By the time you get around to setting up a diabetes blog, the statute of limitations has already run out, and you should be in your "make the best of it" phase, not your "why me?" phase.

I try to set a positive tone myself, with exceptions. I like to poke fun at bad journalism on the subject of diabetes, certainly (and there is no shortage of it).  But in regard to diabetes itself, and what we can do about it, I think I'm more positive in outlook than most people commenting on the subject.

Of course, I really haven't been tested yet. So far things have gone pretty much the way I wanted. My challenge will come later. If I stick around long enough, sooner or later my diabetes will become harder to control, or get completely out of control. Then I'll have to deal with medications (and their side effects). And after that, if the medications fail me, I'll have to deal with the diabetes-related health problems which I have avoided so far. Then we'll see how good I am at maintaining a positive tone under trying circumstances.

Regarding the issue of obscene language, I guess I am less sensitive to it than Bob Fenton is, but I do have one objection to it: it's a crutch. Leaning on it too much robs us of the pleasures of innuendo. Say what you will about the Hays Code (the set of censorship rules imposed on Hollywood in 1930), but it certainly inspired the screenwriters to get very clever about suggesting more than could be said. Consider, for example, the series of "Thin Man" films in the 30s featuring William Powell and Myrna Loy as Nick and Nora Charles. In one scene, Nora is teasing Nick about sensationalized newspaper accounts of an incident in which he was barely grazed by a bullet. Nick says, "I'm a hero. I was shot twice in the Tribune". Nora says "I read where you were shot five times in the tabloids." Nick says, "It's not true! He didn't come anywhere near my tabloids." People don't write as cleverly as that these days, mainly because they don't have to. Maybe if they pretended that they had to, they would develop a little more ingenuity -- and we would all benefit by that.

Thursday, September 3, 2009  

Great -- I don't have to report for jury duty tomorrow! And, because I was on hold for jury duty all week and didn't get called, they're finished with me.

The trial lawyers will probably be happier without my services as a juror, to be honest. I tend to be very suspicious of the way things are presented to me -- in the jury box I would be constantly wondering what I'm being deceived about and why. And if I decided that the lawyer for either side was deliberately misleading me, or trying to manipulate my feelings in an inappropriate way, I would become very reluctant to believe anything he said from that point on. I don't like to give anyone -- lawyer, politician, or salesman -- more than one chance to play me for a sucker.

So, with me not serving on a jury this week, everyone wins! Especially me, which at the moment is what I care about.

Hot weather has briefly returned to the area -- I had a hard time cooling off after I ran at lunch, and when I returned to my desk I was feeling a bit conspicuous because of the damp patches all over my clothes. (It didn't matter -- I wasn't meeting with anyone at that time, and I dried off by the time I needed to see anybody.)

Inspired by the example of one of my running buddies, I brought some vegetables to work to munch on (I tend to get hungry in the afternoon, and vegetables are a better solution to the problem than any of the usual high-carb snacks.) After I got home from work, my neighbor brought me some vegetables (cucumbers and cherry tomatoes) from her garden. She also brought me some plums -- warning me that they were very ripe and should be consumed soon. I had one of them after I got home from my music lesson tonight; I hope it doesn't elevate my fasting test tomorrow; it was very juicy and very sweet. But it was also small, so how much harm could it do me? (We'll see!)

Tonight's music lesson was less stressful than last Thursday's, so my blood pressure was within bounds this time. Some long-standing unresolved issues at work are being settled, too, and that helps. For months it has been unclear which of two big projects I was going to be assigned to (and for a while the plan seemed to be that I would do both, even though it was clearly impossible). Now they've decided to put me on one of the two projects, and it's the one I would have chosen if I had a choice, so all's well that end's well. 

We like to talk about stress reduction, but all we really have control over is how well or badly we handle whatever stress we are obliged to experience. How much stress is going to be in our lives is mostly decided by other people, unfortunately. Well, I guess I'm lucky: the other people have decided, for the moment, to reduce my stress rather than to increase it. I hope they stick to that plan!

Wednesday, September 2, 2009  

Stravinsky once made the nasty observation that Vivaldi didn't really write 600 concertos -- he just wrote the same concerto 600 times. Putting aside the question of how fair or unfair Stravinsky was to Vivaldi's musical creativity, I have to admit that I have a similar reaction when I try to keep up with reports on recent diabetes research.

I'm usually disappointed by the articles I read on the subject, specifically because each one gives me the feeling that I've read it before, with a few details changed. Nearly all articles on diabetes research seem to fit into a handful of familiar categories. Researchers don't seem to make new and startling discoveries; they make the same few discoveries over and over, with minor variations.

One particularly fertile category is research which shows that, if you do something or other to mice, you can prevent them from becoming obese and diabetic. This discovery, whatever it is exactly, is intially claimed to hold great promise for the prevention of obesity and diabetes in humans, but a few years later it turns out that it only works for mice. (Remember leptin?) A current example, reported by researchers at the University of Montreal, has to do with "enhanced blueberry juice" -- that is, blueberry juice that has been acted upon by a bacterium which is often found on the skin of the fruit, particularly in certain varieties of the fruit that are grown in Canada. The enhanced blueberry juice greatly reduced blood sugar levels in mice predisposed to obesity and Type 2 diabetes. It's not clear how the blueberries achieved this, but it is noted in the article that the action of the bacterium quadruples the level of antioxidants in the blueberries. Of course! Antioxidants have become for diet researchers what the Heisenberg Uncertainty Principle has become for science-fiction authors: an all-purpose explanation for anything which doesn't make sense. If the demands of the plot require the Starship Enterprise to travel faster than light (or backwards in time), just mention Heisenberg and suddenly anything is possible. Scotty, beam down some antioxidants to us, so that we can escape from this timewarp!

Then there is the research article which reveals that some enzyme or gene -- hitherto obscure or entirely unknown -- seems to be the underlying cause of diabetes. A recent discovery of this type was made by researchers at the Karolinska University Hospital in Stockholm, Sweden. They found that a gene known as PGC-1, which controls the rate at which cells burn glucose or fats, functions differently in diabetes patients -- and that the functioning of this gene is altered by behavioral factors (what people eat, and how active they are) even though the underlying DNA sequence for the gene is not changed. Predictably, the scientists are less excited by the possibility that behavioral changes can prevent or alleviate diabetes than by the possibility that a medication could be crafted to undo the behavior-based disruption of the gene: "They were able to block hypermethlyation of PGC-1 by silencing a gene that encodes one of a few enzymes that transfer extra methyl groups to DNA. Drugs that prevent hypermethlyation might find clinical use, they say, particularly if they could be made to work only on specific tissues." On a less mercenary note, the researchers said that their findings suggest that we don't have to be prisoners of our genes -- that our behavioral choices can affect what our genes do, even though we can't do anything about which genes we have. It all sounds very exciting, but just wait a few days, and it will turn out that some other gene or enzyme is the cause of diabetes -- I can pretty much guarantee it.

Another common type of research article is one which purports to show that some prescription medication for diabetes is wonderfully effective. However, on closer inspection, it turns out that the researchers didn't compare a given drug to all other ways of treating diabetes, and certainly not to behavior-based diabetes management. They compared the drug to doing nothing, or they compared high dosages to low dosages, or they compared one drug to one other drug, or they compared a combination of three drugs to just one drug. Bottom line: the drug treatment they studied is better than at least one other thing you could do. But what treatment couldn't pass a test that easy? You're not entitled to an Oscar just because somebody made a worse film than yours last year.

Well, I'll keep studying reports of of the latest research, hoping to see results which seem both original and compelling -- but my optimism is fading over time!

I still don't have to report to jury duty tomorrow -- and if it turns out I don't have to do it Friday either, I'm done! Maybe that's why my blood pressure is so low tonight.

Tuesday, September 1, 2009  

I like to think that I've left far behind me the whole issue of getting motivated to exercise -- that I simply do my daily workouts like a good boy, without complaining and without feeling sorry for myself. I don't need to talk myself into working out, overcoming my natural reluctance, because that natural reluctance is something I have ceased to feel.

This is mostly true. It's not always true, however. I still have days when I'm just not feeling in the mood. On those days I do have to struggle with the temptation to skip a planned workout, and rationalize some kind of lame excuse.

Today was one of those days, I guess. I didn't run at lunchtime, because my running buddies were unavailable today, and without peer pressure I just didn't feel like getting out there and doing what needed to be done. I was planning to do weights at the gym tonight anyway, so I thought I'd just run on the treadmill after I got done with the weights. Well, I did all that eventually, but I did it pretty late, and pretty reluctantly. The whole thing was just one long, unpleasant struggle against the urge to stop the workout and go home.

It's mainly weight-training that gives me a motivation problem. I know that weight-training is a valuable complement to the aerobic workouts I more often do, and that it's best to do both kinds of exercise. The problem is that I have learned to like aerobic exercise, and I haven't learned to like weight-training. Whether I'm using weight machines or lifting free weights, I feel incompetent, and I'm fearful of injuring myself. Not that I'm especially competent or safe when I'm running or cycling or swimming; it's just that I don't feel as bad when I'm doing those aerobic sports as I do when I'm lifting weights.

So, tonight, I had a hard time dragging myself to the gym, and a hard time keeping myself there until my task was done. I did it, all right, but I'd like to feel better about it.

Maybe I just need a little more time. I gave up weight-training for a long time, because of shoulder problems. During that time I became very comfortable with the routine of daily running, but I didn't build up a similar level of comfort with lifting weights, because I wasn't lifting weights. Now I'm lifting again, and not much enjoying it, but probably it will get easier if I keep doing it for a while.

Well, here's hoping I'll feel better tomorrow. My running buddies should be free, and maybe I'll be bounding up those hills like a new person.

I still don't have to the report to the courthouse for jury duty tomorrow -- I just have to call in tomorrow night and see if they need me on Thursday. I hope my luck holds! If I make it to Friday without being put on a jury, I'm home free.

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