Happy New Year

Three simple steps to a healthy new year

1. Add Vaccination to Your List of Resolutions – Getting vaccinated is the best way to protect yourself and your loved ones from the flu. To find the H1N1 and seasonal flu vaccine clinics nearest you, visit www.maineflu.gov or call 211 for Maine-based clinics, or visit www.flu.gov for clinics elsewhere. There are more clinics being added every day, so check it out!

2. Be a Germ Stopper – Cover your nose and mouth when you cough or sneeze, wash your hands often, and avoid touching your eyes, nose and mouth. Germs spread this way. Also, stay home if you are sick and avoid close contact with people who are sick. For additional information, see how to prevent and treat the flu.

3. Check the Facts and Stay Informed – Visit www.maineflu.gov or www.flu.gov regularly for the latest information. Heard a rumor? Visit Myths & Facts to run a fact check. Have a question? Email us at flu.questions@maine.gov or call 211. Want to stay informed? Sign up for the RSS feed or Maine CDC on Facebook or Maine CDC on Twitter for our weekly updates, health advisories, and/or press releases.


If you’ve been vaccinated already, please share this message with friends and family and let them know why the H1N1 vaccine is safe and recommended by health experts. The 2009 H1N1 flu vaccine is made the same way as the seasonal flu vaccine. Millions of people have safely received the H1N1 vaccine, including the President, First Lady and their children.

Also, consider posting a flyer at your work, school and local community centers. www.maineflu.gov and flu.gov offers free outreach materials available in multiple languages.

The Story of a Bureaucratic Jungle

This letter is for all those who believe it is possible to break out of the cycle of poverty by getting a job and leaving the social programs behind.

I was naive enough to believe the same thing once, too. I have a physical disability which requires me to use a wheelchair, but that should not be enough to stop me from working, right?

Wrong.

I got a job in 2007 at a place that was appropriate to my physical limitations. The building was accessible and the task of using a phone and a computer was completely doable. The only issue was that the business was a 24-hour operation.

For 17 months, there was a recognition that it was best to stabilize the time of my shift because if I robbed myself of too much sleep I would have "meltdowns" that would limit my productivity.

The accommodated shift enabled me to schedule things in a way that meant I rarely had to miss work. Other than a few doctor's appointments and a bad reaction to a minor surgical procedure, I was always able to be there.

My supervisor even congratulated me for not having any unsubstantiated absences. This recognition made me feel proud because I believe in being dependable and it was obvious my efforts were being recognized.

Unfortunately for me, in early July my work situation changed completely. My employer decided that my shift could no longer stay the same. The management moved my shift to a new time of 11:15 am - 7:15 pm. Their idea of accommodation was to leave the new shift stable for 6 months.

I tried to negotiate a better time, but they would not agree to change it.

The fly in the ointment is this: the new shift is one that is impossible to manage with my need to rely on the pre-booked services of the Access Bus, attendant care services, nursing services, and the limited ability to access the majority of goods and services in Kingston because of barriers. When the Access Bus strike ended, a major funding contract had been lost, so 5 daytime and 1 nighttime bus had to be taken off the road.

With a severe allergy to perfume that often requires me to get out of the city bus because I can't breathe, I cannot really say I have reliable access to transit to get the basic tasks of everyday living done in a timely fashion anymore.

The realization that I would soon have to be pushing myself even harder to try to keep up with the new shift was too much. Stress got the better of me and I had to go out on sick leave.

But it gets better... Not really. Work rejected the pro-active medical that I got from my doctor in an attempt to prevent having to leave in the first place. Then, when I had to go on leave, I had to get a medical. Shepell FGI, the company handling those who were on long term leave, rejected it.

I had 30 days to appeal. I asked my doctor to fill out my appeal form, and after he had completed the task, I made the mistake of asking him about a few inaccuracies.

They were subjective statements about issues at work that he could not have witnessed. The appeal form he'd filled out was also missing some details that were requested by Shepell FGI and that were required for the appeal. The doctor must have taken my requests badly because he walked out of the room and told me to find another doctor.

In any case, I paid for the appeal, as it was written, and left. I sent it to Shepell FGI. This medical too, was rejected. I was now facing the accusation of job abandonment.

With no treatment to get over the emotional trauma, no doctor, and nowhere to turn, I called ARCH Legal Services for advice. They recommended I resign rather than be fired because, of the two options, resigning was better. They also recommended I consider filing a challenge under human rights.

I was not comfortable with clubbing my employer with a threat of a human rights challenge so I tried to negotiate a solution once more. I wrote a letter to my employer and, once again, asked for a better time for the new shift.

I added a note saying that even though my employer was subjecting me to undue hardship and was morally wrong, legally my place of employment also had a duty to accommodate. My employer refused to accommodate me once again. I finally realized I had been beaten. I sent in my letter of resignation.

What I never expected was the severe financial devastation that would soon follow.

I live in subsidized housing so I reported the sudden loss of income in early August, which is ample time for my rent to be adjusted downwards, but my landlord didn't get around to processing the change on time.

Instead, in September, my landlord took approximately $300.00 too much out of my bank account for rent, using the auto debit feature I opted into using several years ago.

When I asked for it back, they told me it was to be credited back over the next two months. I could not believe it.

This meant the only way I could eat was to use my line of credit to buy groceries. Eating at home would be cheaper than paying $4.50 for a two-way bus trip to Martha's table plus $1.00 for the meal.

Needless to say, when housing sent me its decision about crediting the amount back over two months, I appealed it.

The appeal has been with housing for a month. The last thing I heard was that it has been passed back to the employee who had originally made the mistake. I guess this means they are allowed to investigate themselves.

In the meantime, with E.I. sick benefits not giving me enough to live on, I went to ODSP to apply for rapid reinstatement.

Little did I know that an income eligibility review would determine that I could not even get coverage for Disability Related Disability Related Items, let alone a drug card, dental card, glasses, wheelchair repairs, etc. I could not get this coverage because my source of income was from another level of government and the income did not come from one of the prescriptive sources named in Directive 5.9. Here is a quote from the directive:

Summary of Directive (Source: Directive 5.9)
  • Accident settlements and payments from trusts derived from an inheritance or life insurance policy and gifts or other voluntary payments may be exempt from treatment as assets and income if they are applied to expenses for approved disability-related items or services. Also exempt are payments that are made pursuant to a court order or government-funded program, that are specifically made for the purpose of, and are applied to expenses for approved disability related items and services. My income was $932.00 per month from E.I.
  • The Director may approve an increased asset limit where assets are being accumulated to purchase an approved disability related item or service, up to the maximum of the prescribed asset limit plus the amount needed for the items and services.
  • Approved disability related items and services include, but are not limited to: assistive devices; support services; health maintenance, health care and safety items and services; renovations; education and training items and services. I definitely qualified for these.
I am getting E.I. so for now I have some income but it is not enough to cover expenses. I have no choice but to sink ever deeper in debt.

What makes my predicament even more difficult is I haven't been able to get legal advice, even though I have asked, and I can't get counseling or emotional support because I do not have a diagnosed mental illness. This refusal of services means I am left to sort this mess out on my own.

Without a family doctor, I can't even get medication to stop the panic attacks or the repeated bouts of tearfulness that are caused by the anger. In answer to your unasked question I have to inform you that after hours clinics and the emergency department will not treat people with pre-existing conditions.

The GP that just walked out on me is the second one in 6 months. The first physician suggested I move on because a teaching facility is not set up to deal with the longer-term issues associated with having a disability.

The second doctor apparently can't handle the frustration of someone who desperately wanted to keep her job and was concerned by the contents of the letter of appeal which offered no indication that his patient would get any support whatsoever from the doctor.

When I got the registered letter from my doctor to confirm he has severed our relationship, it said I could call the College of Physicians for help in finding a new one. I did as the doctor requested. The College of Physicians of Ontario gave me the phone number for Health Care Connect and I called them.

Would you believe Health Care Connect said the doctor has not notified it to say he has discharged me? This means that I am unable to access Healthcare Connects' services.

I have three choices. I can wait for the doctor to finish the process of severing our relationship, or call him and tell him to finish all the formalities, or call the Ministry of Health Info line. I can't handle the stress of any of that right now.

When I realized how deep I was into this Catch 22, I wheeled down to the MPP's office after stopping at the Kingston Community Counseling Centre and the Kingston Community Legal Clinic, to ask for their help. I dumped the whole lot onto the office of my MPP.

Most of the issues are outside of their jurisdiction, but the office assistant, Anita said she would make several phone calls to see what she could do to help.

All I can say is thank God. I still can't believe I had to quit my job because of an absolute refusal to accommodate the time of my new shift due to the inflexibility of my disability supports, let alone go through the pain of losing my doctor and not being able to get a new one until he finished formally severing the relationship. To then have housing make a mistake that resulted in not being able to get back on ODSP right away and to be told I can't qualify for emotional support because I do not have a diagnosed mental illness is too much. E.I. gives me about the same income as an ODSP cheque, but it doesn't cover the added medical expenses like mandatory medical supplies, paying for wheelchair repairs, a dentist, or if I get a prescription, a drug card.

How much can one person be expected to take, before it is acknowledged that it is too much? This nightmare has been caused by mistakes, insensitivity, and lack of knowledge about the impact of having a disability.

I may not have a diagnosed mental illness but I'm so overwhelmed and angry that I can't function. I need some emotional support because the ability to be civil, polite and respectful when asking for help is long gone. However, being deemed mentally sound means I can't even have that. Why?

I'm starting to think a lobotomy would be the most kind and civil thing the medical profession could do for me. They could remove the thinking, feeling part of me, then lock me away and let me live out the rest of my days useless.

Please read my other Blogs:
Transit: http://wheelchairdemon-transit.blogspot.com
Health: http://wheelchairdemon-health.blogspot.com

Important updates for Vaccine Administrators

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 30, 2009


H1N1 Vaccine Supply and Prioritization
We expect to have close to 700,000 cumulative doses of H1N1 vaccine in the state by January 4th – enough for more than half of the state’s population.

The nasal spray vaccine is generally more available than injectable vaccine. We request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 years old who are not pregnant. For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf.

We have and expect sufficient supplies to meet the demand for vaccine on a weekly basis, but it often takes 7-10 days to replenish a health care provider’s vaccine supply. Additionally, we have experienced delays in distributing vaccine the past two weeks primarily due to federal CDC holiday shipping schedules and to some degree the state shutdown day. We expect these delays to dissipate the first week of January, though snowstorms in Maine or on the East Coast can also cause some delays.

We are extremely grateful for the thousands of Maine health care providers who have been offering vaccine to their patients and volunteering with many vaccination efforts. We hope to continue and even increase these efforts now that more vaccine is flowing into the state, since this is our window of opportunity to protect people before the next wave of H1N1 infection and as H1N1 continues to circulate. Our first priority is to make sure traditional health care providers (hospitals, private practices, health centers, home health agencies, municipal health departments) have sufficient vaccine. We are also increasingly distributing vaccine to other health care providers, such as those in employment and in retail settings. Offering vaccine in these other settings will help serve many people who may have difficulty seeking vaccine in traditional health care settings and will help reduce the burden on traditional health care providers.

Important Information for Vaccine Administrators
Vaccination is the best way to protect patients and to slow down the circulation of the virus, which will also help to prevent changes in the virus. Maine CDC encourages all appropriately licensed health care providers to register for, order, and offer H1N1 vaccine to their patients, including those health care providers in non-traditional settings for vaccine, such as specialists and those providing care for populations who may not seek vaccine, such as those with serious mental illness.

For health care providers to receive vaccine for the first time to administer to patients there is a simple two-step process:
1. Register for a PIN: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml.
2. Once the PIN is received, place an order for vaccine:http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml.

Please note that all H1N1 vaccine providers and/or administrators must submit the vaccine administration data into Maine CDC’s weekly vaccine reporting system. The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. Detailed instructions are also available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Weekly-Reporting-Form-instructions.pdf.

If a health care provider is already registered but is running low on H1N1 vaccine, the provider should:
Confirm that you have placed orders for all the vaccine you need. You may order more by completing this form: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-orderform.shtml.
It often takes 7-10 days to replenish a health care provider’s vaccine supply. If you have acute vaccine needs or other related concerns or questions, email flu.questions@maine.gov or call the Immunization Program at: 287-3746 or toll free at 1-800-867-4775 Monday – Friday 8 am – 5 pm.

If local vaccine supplies are not sufficient while awaiting more vaccine, Maine CDC recommends focusing the limited supply on those patients in the five high priority groups (pregnant women, people ages 6 months through 24 years-old, people 25 through 64 years-old with an underlying medical condition, caregivers and household contacts of infants younger than 6 months, and health care workers). Patients can also be referred to public clinics which can be found by calling 211 or checking www.maineflu.gov.

When a health care provider’s vaccine supply is sufficient, we recommend offering vaccine to every patient at every visit, so long as there are no contraindications for receiving vaccine. It is important to take advantage of this window of opportunity (declining disease burden and expanded vaccine supply) to encourage vaccine. Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them should contact their local vaccine coordinator to arrange for redistribution.

Vaccine Coordinators:

District 1 – York: Sharon Leahy-Lind, 490-4625, sharon.leahy-lind@maine.gov

District 2 – Cumberland: Becca Matusovich, 797-3424, becca.matusovich@maine.gov

District 3 – Western Maine: MaryAnn Amrich, 753-9103, maryann.amrich@maine.gov
(Franklin, Oxford, and Androscoggin counties)

District 4 – Mid Coast: Jen Gunderman-King, 596-4278, jennifer.gunderman-king@maine.gov
(Waldo, Knox, Lincoln, and Sagadahoc counties)

District 5 – Central Maine: Sue Lee, 592-5634, susan.j.lee@maine.gov
(Somerset and Kennebec counties)

District 6 – Penquis: Jessica Fogg, 592-5633, jessica.fogg@maine.gov
(Penobscot and Piscataquis counties)

District 7 – Downeast: Al May, 263-4975, alfred.may@maine.gov
(Washington and Hancock counties)

District 8 – Aroostook: Stacy Boucher, 592-5632, stacy.boucher@maine.gov

Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15, jireland@maliseets.com

Vaccine Return:
The only vaccines that should be returned are those that arrive non-viable or appear to be damaged during transit. Providers with concerns about vaccine viability during transit from the McKesson Distributor should call 877-836-7123 immediately upon receipt of the package.

Once a provider takes receipt of the vaccine as a usable product, it is that provider’s responsibility to ensure proper disposal of any damaged, expired, or un-used vaccine unless it has been recalled. Health care providers who have sufficient supplies and no longer need vaccine they receive should contact their local vaccine coordinator (listed above) to arrange for redistribution.

Vaccinating Small Children:
Due to national production delays and the recent recall of 0.25 mL pre-filled syringes, Maine CDC makes the following recommendations for vaccinating small children:
Use the Sanofi or CSL multidose vial for all children ages 6 months to two years of age
Use the nasal spray vaccine for healthy children ages two years and older, when available and appropriate
Use the Sanofi or CSL multidose vial for children ages two and older who are not eligible to receive nasal spray vaccine, or when nasal spray is unavailable

Vaccine Dose Spacing and Administration:
Those who have questions about H1N1 vaccine dose spacing and administration with seasonal flu or other vaccines should consult this table from US CDC: http://www.cdc.gov/H1N1flu/vaccination/dosespacing_admin.html.

Additional vaccine-related information for health care providers, including information on billing and consent forms can be found on our web site at: www.maineflu.gov or specifically on: http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml.


To read the full weekly update: http://www.maine.gov/tools/whatsnew/attach.php?id=87323&an=2

The Body Fat Setpoint

One pound of human fat contains about 3,500 calories. That represents roughly 40 slices of toast. So if you were to eat one extra slice of toast every day, you would gain just under a pound of fat per month. Conversely, if you were to eat one fewer slice per day, you'd lose a pound a month. Right? Not quite.

How is it that most peoples' body fat mass stays relatively stable over long periods of time, when an imbalance of as little as 5% of calories should lead to rapid changes in weight? Is it because we do complicated calculations in our heads every day, factoring in basal metabolic rate and exercise, to make sure our energy intake precisely matches expenditure? Of course not. We're gifted with a sophisticated system of hormones and brain regions that do the "calculations" for us unconsciously*.

When it's working properly, this system precisely matches energy intake to expenditure, ensuring a stable and healthy fat mass. It does this by controlling food seeking behaviors, feelings of fullness and even energy expenditure by heat production and physical movements. If you eat a little bit more than usual at a meal, a properly functioning system will say "let's eat a little bit less next time, and perhaps also burn some of it off." This is one reason why animals in their natural habitat are nearly always at an appropriate weight, barring starvation. The only time wild animals are overweight enough to significantly compromise physical performance is when it serves an important purpose, such as preparing for hibernation.

I recently came across a classic study that illustrates these principles nicely in humans, titled "Metabolic Response to Experimental Overfeeding in Lean and Overweight Healthy Volunteers", by Dr. Erik O. Diaz and colleagues (1). They overfed lean and modestly overweight volunteers 50% more calories than they naturally consume, under controlled conditions where the investigators could be confident of food intake. Macronutrient composition was 12-42-46 % protein-fat-carbohydrate.

After 6 weeks of massive overfeeding, both lean and overweight subjects gained an average of 10 lb (4.6 kg) of fat mass and 6.6 lb (3 kg) of lean mass. Consistent with what one would expect if the body were trying to burn off excess calories and return to baseline fat mass, the metabolic rate and body heat production of the subjects increased.

Following overfeeding, subjects were allowed to eat however much they wanted for 6 weeks. Both lean and overweight volunteers promptly lost 6.2 of the 10 lb they had gained in fat mass (61% of fat gained), and 1.5 of the 6.6 lb they had gained in lean mass (23%). Here is a graph showing changes in fat mass for each individual that completed the study:

We don't know if they would have lost the remaining fat mass in the following weeks because they were only followed for 6 weeks after overfeeding, although it did appear that they were reaching a plateau slightly above their original body weight. Thus, nearly all subjects "defended" their original body fat mass irrespective of their starting point. Underfeeding studies have shown the same phenomenon: whether lean or overweight, people tend to return to their original fat mass after underfeeding is over. Again, this supports the idea that the body has a body fat mass "set point" that it attempts to defend against changes in either direction. It's one of many systems in the body that attempt to maintain homeostasis.

OK, so why do we care?

We care because this has some very important implications for human obesity. With such a system in place to keep body fat mass in a narrow range, a major departure from that range implies that the system isn't functioning correctly. In other words, obesity has to involve a defect in the system that regulates body fat, because a properly functioning system would not have allowed that degree of fat gain in the first place.

So yes, we are overweight because we eat too many calories relative to energy expended. But why are we eating too many calories? There are a number of reasons, but one reason is that the system that should be defending a low fat mass is now defending a high fat mass. Therefore, the ideal solution is not simply to restrict calories, or burn more calories through exercise, but to try to work with the system that decides what fat mass to 'defend'. Restricting calories isn't necessarily a good solution because the body will attempt to defend its setpoint, whether high or low, by increasing hunger and decreasing its metabolic rate. That's why low-calorie diets, and most diets in general, typically fail in the long term. Restricting calories works for fat loss, but most people find it miserable to fight hunger every day.

This raises two questions:
  1. What caused the system to defend a high fat mass?
  2. Is it possible to modify the fat mass setpoint, and how would one go about it?
Given the fact that body fat mass is much higher in many affluent nations than it has ever been in human history, the increase must be due to factors that have changed in modern times. I can only speculate what these factors may be, because research has not identified them to my knowledge, at least not in humans. But I have my guesses. I'll expand on this in the next post.


* The hormone leptin and the hypothalamus are the ringleaders, although there are many other elements involved, such as several gut-derived peptides, insulin, and a number of other brain regions.

Enigma Variation

The melancholy gap between Christmas and New Year is helped along by the Market Harborough Book Fair. Shelves bending under the marshalled ranks of volumes, (why can't I stop myself tidying them up as I go round?), with baize covered tables displaying choice items opened at the best bits, and the church hall window sills put to good use for what are obviously considered the also rans. Where I found this lovely 1950's guide to the town of Malvern, set in one of my favourite parts of England, Elgar's Malvern Hills. "Come to Malvern", says the back cover, "for scenic beauty, pure air and a warm welcome". The advertisements at the back use stock blocks of cows and sheep for local butchers and big briars for tobacconists, and a garage tempting you with the new Standard Vanguard has the telephone number 147. But just look at this front cover. This is what they call 'artistic licence' and whoever did this took a great big one out. The Malvern Hills are dramatic enough, but try as you might you'll be hard pushed to get this perspective of the town. To be honest, I think all he (or she) had to go on was a blurred photograph of the Priory and the thought that there was a hill somewhere near. But it works and is beautiful in its own way, and I expect brought them in their thousands to sample the delights of butchers, tobacconists, garagistes, drapers and outfitters, all clinging to the side of these wonderful Worcestershire hump-backed hills.

Christmas Time


Rabbits on a High-Saturated Fat Diet Without Added Cholesterol

I just saw another study that supports my previous post Animal Models of Atherosclerosis: LDL. The hypothesis is that in the absence of excessive added dietary cholesterol, saturated fat does not influence LDL or atherosclerosis in animal models, relative to other fats (although omega-6 polyunsaturated oils do lower LDL in some animal models). This appears to be consistent with what we see in humans.

In this study, they fed four groups of rabbits different diets:
  1. Regular low-fat rabbit chow
  2. Regular low-fat rabbit chow plus 0.5 g cholesterol per day
  3. High-fat diet with 30% calories as coconut oil (saturated) and no added cholesterol
  4. High-fat diet with 30% calories as sunflower oil (polyunsaturated) and no added cholesterol
LDL at 6 months was the same in groups 1, 3 and 4, but was increased more than 20-fold in group 2. It's not the fat, it's the fact that they're overloading herbivores with dietary cholesterol!

Total cholesterol was also the same between all groups except the cholesterol-fed group. TBARS, a measure of lipid oxidation in the blood, was elevated in the cholesterol and sunflower oil groups but not in the chow or coconut groups. Oxidation of blood lipids is one of the major factors in atherosclerosis, the vascular disease that narrows arteries and increases the risk of having a heart attack. Serum vitamin C was lower in the cholesterol-fed groups but not the others.

This supports the idea that saturated fat in the absence of excess dietary cholesterol does not necessarily increase LDL, and in fact in most animals it does not.

Merry Christmas!

Trained volunteers can help when emergencies arise

Picture an emergency response worker. Chances are you are thinking of someone official, like a police officer, paramedic or firefighter. But many of the people who play key roles during a disaster are people just like you who’ve stepped up and volunteered to help out. So here’s a key step for communities when planning for the worst: recruit and train good volunteers.

According to a 2008 community preparedness guide (pdf) from the Western New York Public Health Alliance Inc., volunteers should have a range of skills, including pharmacists; people who can communicate in different languages, including sign language; custodians; faith leaders; and county, school and government officials. Chances are your community can use someone with your skills as well.

Organizers should train volunteers in handling population surges, understanding how to respond to quarantine or hazardous materials situations, and calming people down. Volunteers also need to be informed of their legal rights and have emergency management training such as that offered through the Community Emergency Response Team program. Such training is often held one evening per week for seven weeks and is offered in many states, so if you want to help, check if it’s in your area.

In addition to training, volunteers need to also have the right attitude. According to the Louisiana 4-H Council volunteers need to be accepting, aware, attentive and have a positive attitude when dealing with disaster victims. If that sounds like you, then step up and make yourself known.

It’s also essential for planners to over-recruit volunteers in case some don’t show up when duty calls. Volunteers should know their town’s emergency preparedness plan and have copies of each other’s contact information.

If volunteers are properly trained and willing to help during an emergency, it can make all the difference when a crisis hits.

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A.M. Casual for the Daytime, P.M. Sleek for Evening




(Click on the images to see the full-size versions.)
Source: Modern Beauty Shop, January 1943

Christmas Girl

Christmas Tree Decorations

My Christmas Tree

Stopping By Woods

A minor road from Leicestershire into Rutland crosses the Eye Brook and climbs in a series of twists and turns to the top of Kings Hill. On the last but one bend a stand of beeches crowns a bluff of land that gives panoramic views of the Beaumont Chase below. I always slow down here, and often just get out of the car by a gate and stand listening to the sighing of the wind in the branches. There is something very special about this place, and one of my New Year resolutions is to find out more. Early yesterday morning a heavy ice laden mist was covering the hilltop, and once again the boles of these trees drew me in. It was eerily quiet, and brought to mind Robert Frost's poem Stopping by Woods on A Snowy Evening, the last verse of which is:

The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

If you're travelling too, please take care. And a very merry Christmas and Happy New Year to you all.


What's the Ideal Fasting Insulin Level?

[2013 update.  I'm leaving this post up for informational purposes, but I think it's difficult to determine the "ideal" insulin level because it depends on a variety of factors including diet composition.  Also, insulin assays are not always comparable to one another, particularly the older assays, so it's difficult to compare between studies]

Insulin is an important hormone. Its canonical function is to signal cells to absorb glucose from the bloodstream, but it has many other effects. Chronically elevated insulin is a marker of metabolic dysfunction, and typically accompanies high fat mass, poor glucose tolerance (prediabetes) and blood lipid abnormalities. Measuring insulin first thing in the morning, before eating a meal, reflects fasting insulin. High fasting insulin is a marker of metabolic problems and may contribute to some of them as well.

Elevated fasting insulin is a hallmark of the metabolic syndrome, the quintessential modern metabolic disorder that affects 24% of Americans (NHANES III). The average insulin level in the U.S., according to the NHANES III survey, is 8.8 uIU/mL for men and 8.4 for women (2). Given the degree of metabolic dysfunction in this country, I think it's safe to say that the ideal level of fasting insulin is probably below 8.4 uIU/mL.

Let's dig deeper. What we really need is a healthy, non-industrial "negative control" group. Fortunately, Dr. Staffan Lindeberg and his team made detailed measurements of fasting insulin while they were visiting the isolated Melanesian island of Kitava (3). He compared his measurements to age-matched Swedish volunteers. In male and female Swedes, the average fasting insulin ranges from 4-11 uIU/mL, and increases with age. From age 60-74, the average insulin level is 7.3 uIU/mL.

In contrast, the range on Kitava is 3-6 uIU/mL, which does not increase with age. In the 60-74 age group, in both men and women, the average fasting insulin on Kitava is 3.5 uIU/mL. That's less than half the average level in Sweden and the U.S. Keep in mind that the Kitavans are lean and have an undetectable rate of heart attack and stroke.

Another example from the literature are the Shuar hunter-gatherers of the Amazon rainforest. Women in this group have an average fasting insulin concentration of 5.1 uIU/mL (4; no data was given for men).

I found a couple of studies from the early 1970s as well, indicating that African pygmies and San bushmen have rather high fasting insulin. Glucose tolerance was excellent in the pygmies and poor in the bushmen (5, 6, free full text). This may reflect differences in carbohydrate intake. San bushmen consume very little carbohydrate during certain seasons, and thus would likely have glucose intolerance during that period. There are three facts that make me doubt the insulin measurements in these older studies:
  1. It's hard to be sure that they didn't eat anything prior to the blood draw.
  2. From what I understand, insulin assays were variable and not standardized back then.
  3. In the San study, their fasting insulin was 1/3 lower than the Caucasian control group (10 vs. 15 uIU/mL). I doubt these active Caucasian researchers really had an average fasting insulin level of 15 uIU/mL. Both sets of measurements are probably too high.
Now you know the conflicting evidence, so you're free to be skeptical if you'd like.

We also have data from a controlled trial in healthy urban people eating a "paleolithic"-type diet. On a paleolithic diet designed to maintain body weight (calorie intake had to be increased substantially to prevent fat loss during the diet), fasting insulin dropped from an average of 7.2 to 2.9 uIU/mL in just 10 days. This is despite a substantial intake of carbohydrate, including fruit and vegetable sugars.  The variation in insulin level between individuals decreased 9-fold, and by the end, all participants were close to the average value of 2.9 uIU/mL. This shows that high fasting insulin is correctable in people who haven't yet been permanently damaged by the industrial diet and lifestyle. The study included men and women of European, African and Asian descent (7).

One final data point. My own fasting insulin, earlier this year, was 2.3 uIU/mL. I believe it reflects a good diet, regular exercise, sufficient sleep, and a relatively healthy diet growing up. It does not reflect: carbohydrate restriction, fat restriction, or saturated fat restriction.

So what's the ideal fasting insulin level? My current feeling is that we can consider anything between 2 and 6 uIU/mL within our evolutionary template.

Pink Christmas

Orange Christmas

Where's That Then? No 5


Your Unmitigated Traveller struggled through blizzards of snow and ice to bring you this morning's puzzle location. I wanted to show you Clackett's Lane Services on the M25 yesterday afternoon, because for all the world it looked like a frontierman's cabin. All it needed was a grizzly bear leaning-up against a litter bin, but the necessity to load up with pork pies and giant sausage rolls and get going again was overwhelming. I honestly thought I was the going to be the last one out of Kent. So instead here's a warmer holiday photograph from Mr.Gullers.

Drene's Costume Coiffure of the Month: Winged Victory



(Click on images for full-size versions.)
Source: American Hairdresser, November 1942

Preparing For Christmas

New Year Sparkle!



(Take advantage of the high res scans by clicking on the images and seeing the full-size version. That way, you can even read the text.)
Source: Modern Beauty Shop, January 1943


Here's a hairdo for the holiday party season. The secret is in the accessories.

Christmas Tree Decorations

Christmas is Coming Soon

Snowflakes

Sheltering in place is a snap with the right know-how

“Warning! Seek shelter!” If you heard this message right now, would you be ready?

While emergencies such as fires or hurricanes may call for you to evacuate, others require that you stay put — or “shelter in place” — to keep safe. According to the Centers for Disease Control and Prevention, sheltering in place means to stay where you are and make the building as safe as possible to protect yourself.

Taking shelter can either be a short-term measure, such as going to a safe room for a brief time during a tornado warning, or long term, where you need to stay in your home for several days. In both instances, it’s important to follow a general set of procedures. If you are recommended by officials to shelter in place, get inside as quickly as possible and tune into any radio or television that may have emergency updates. You may be advised to close and lock all exterior doors and windows, and to turn off air conditioning systems. In the event of a toxic chemical release, make sure to also close all vents, fireplace dampers and as many interior doors as possible.

When preparing for a disaster that requires sheltering in place, it’s important to select a room that will keep you the safest. While the room you choose may change depending on the specific type of disaster, most shelter rooms should be a large room with as few windows and doors as possible. Having access to a clean water source, like a bathroom or kitchen with a sink, is also a plus.

Once you’ve picked your shelter room, keep it stocked with a flashlight, battery-powered radio (with extra batteries for both), emergency food, bottled water, a first aid kit and a telephone or charged cell phone. Setting aside some games or books that will help you while away the time is also a good idea.

Also, don’t assume that emergencies will only happen when you are at home. Check with your office, workplace or school to find out where sheltering locations are, and offer to help if they don’t have one designated yet. You’ll be helping yourself, but also your community, be more prepared when it counts.
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Why this Maine CDC staffer got a nasal spray vaccine

I am a healthy 30-year-old, and I’ve never had a flu shot in my life. (Although I’ve complained to almost anyone who will listen that I had the flu for my seventh and eighteenth birthdays – which made both birthdays completely miserable.)

I normally work in the HIV, STD, and Viral Hepatitis program at Maine CDC, but I’ve been reassigned to help with H1N1 communications since late July. I’ve been combing through scientific jargon, trying to boil it down for people like me who don’t have medical or public health degrees. I’ve been updating our web site, this blog, Facebook, Twitter, and Myspace. I’ve sat through meetings with people who DO have medical and public health degrees and can explain some of the scientific jargon in common sense terms.

I’ve learned a couple of very simple things these last few months: Vaccination is the single most effective way of avoiding the flu, and the benefits of getting the H1N1 vaccine far outweigh the very small risk of serious complications from vaccination.

So, yesterday, I got my very first flu vaccine. I opted for the nasal spray, because I know that it is safe and effective. I’m healthy, not pregnant, well over two years-old and under 49. There was no reason for me NOT to get the nasal spray vaccine (also a first for me). If I had gotten an injected vaccine, it’s possible that I would have deprived someone at high risk from the shot that could save them from getting very sick.

I took pictures of Dr. Mills getting her nasal spray vaccine as well. (If it looks like she’s grimacing, it’s more about the flash from my camera than anything else.)

- Tara Thomas
H1N1 Communications Coordinator, Maine CDC













For more information on nasal spray vaccine:
Our Fact Sheet: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf
Vaccine Information Statement: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-nasal%20-spray.pdf
US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/nasalspray_qa.htm



Note:
Maine CDC is encouraging health care providers with sufficient supplies to provide vaccine to all who want it, and those without sufficient vaccine to focus their supply on those in the high priority groups: pregnant and recently pregnant women; household members and caregivers of infants younger than six months old; all people ages 6 months through 24 years; people ages 25 through 64 with underlying health conditions; and health care and EMS workers.

Over the coming days and weeks, vaccine will become more available in a variety of settings, including health care provider offices, public clinics, retail locations, large employer settings, nursing homes, etc. People have three easy options in seeking vaccine: check the clinic locator at http://www.maineflu.gov/, call 211, or call their health care providers.

For now, we request that nasal spray vaccine be given to anyone who is eligible to receive it. Nasal spray flu vaccine is not new. It has been used successfully in many settings for seasonal flu vaccination since 2003. Even if you come into regular contact with people who cannot receive the nasal spray vaccine themselves you may still be able to receive the nasal spray vaccine as long as you are healthy, not pregnant, and age 2 through 49. The nasal spray vaccine is safe for breastfeeding mothers. Health care workers who cannot receive the vaccine themselves (due to pregnancy, health condition, or age) may still administer the vaccine.

Merry Christmas To You

The Nutcracker

Important updates on vaccine prioritization and recall

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 17, 2009

Highlights
Four deaths due to H1N1 have been reported, bringing the total to 17 since August. Please note that an estimated 150 people die in a normal flu season in Maine.
We are now recommending H1N1 vaccine be made available to anyone who wants it, as local supply allows and with an emphasis on prioritizing injectable vaccine for those at highest risk for complications.
A non-safety recall has been issued for about 800,000 doses of H1N1 vaccine nationwide.
We expect the H1N1 flu virus to continue to circulate and additional surges are also possible. We expect to experience a seasonal flu surge as well, as we normally do sometime in the winter. There is still more influenza across the country than is usually seen this time of year, and vaccination remains the best protection against the flu.
Now is an excellent time to get vaccinated, so you will be protected during the next wave of flu.

Flu Activity in Maine and the US
Data indicate that H1N1 flu has been relatively mild in Maine compared with other states, and continues to decline. Nationally, data indicate that H1N1 is striking young people the hardest. However, there were four deaths among people older than 64 since last week’s update. Those individuals lived in Androscoggin, Kennebec, Knox, and Oxford counties. Note: Three deaths were reported to Maine CDC after the surveillance information at the end of this report was compiled, and therefore will not be reflected in that data.

All 17 deaths since August have occurred in people with underlying health conditions. People with underlying health conditions should seek vaccine at their specialty providers, primary care providers, or at public clinics listed at www.maineflu.gov. Anyone with underlying health conditions who experiences flu-like symptoms should contact his or her health care providers immediately to receive a prescription for antiviral medications (such as Tamiflu®).

There were 11 new hospitalizations due to H1N1 in the last week, down from 31 the week before, all ages 25 and older. One individual older than 64 required intensive care. Counties of those hospitalized this past week are: York, 3; Franklin, Penobscot, and Somerset with two each; and one each in Hancock and Knox counties.

Outbreaks were reported in one long term care facility, one acute care facility, one K-12 school, and two other institutions. The outbreaks occurred in Androscoggin, Cumberland, Oxford, and Penobscot counties.

Flu is unpredictable. Although it appears that flu activity may have peaked during the current wave, other waves of seasonal and/or H1N1 flu may occur. We expect H1N1 to continue to circulate for months, if not years, to come. Take precautions to prevent serious illness: stay home when sick, cover coughs and sneezes, wash hands frequently, and get vaccinated against both seasonal and H1N1 flu when vaccine is available to you.

To remind people of the importance of taking these precautions, order flu posters and magnets for your organization, workplace, or health care practice: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml

H1N1 Vaccine Supply and Prioritization
Since October, we have received more than 500,000 doses of H1N1 vaccine in Maine. Based on recent demand, Maine CDC is now recommending that H1N1 vaccine be offered to anyone who wishes to receive it when local supplies allow. The focus for vaccine will still be the five high priority groups as defined by US CDC, but in many places public clinics will not need to turn others away. We are encouraging health care providers with sufficient supplies to provide vaccine to all who want it, and those without sufficient vaccine to focus their vaccine supply to those in the high priority groups: pregnant and recently pregnant women; household members and caregivers of infants younger than six months old; all people ages 6 months through 24 years; people ages 25 through 64 with underlying health conditions; and health care and EMS workers.

The nasal spray vaccine is available in slightly greater quantities than injectable vaccine. If healthy people who qualify for the nasal spray are given injectable vaccine, this can easily deplete the injectable vaccine supply for those who are most vulnerable to being hospitalized or dying from H1N1. Therefore, we request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 who are not pregnant.

Nasal spray flu vaccine is not new. It has been used successfully in many settings for seasonal flu vaccination since 2003. Even if you come into regular contact with people who cannot receive the nasal spray vaccine themselves you may still be able to receive the nasal spray vaccine as long as you are healthy, not pregnant, and age 2 through 49. The nasal spray vaccine is safe for breastfeeding mothers. Health care workers who cannot receive the vaccine themselves (due to pregnancy, health condition, or age) may still administer the vaccine.

For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf

The benefits of getting the H1N1 vaccine far outweigh the very small risk of serious complications from vaccination. Some people getting vaccinated will have mild side effects such as pain, redness or swelling in the arm where the shot was given or a runny nose and headache after the nasal spray vaccine. US CDC and FDA carefully monitor vaccine reports. After millions of doses of H1N1 vaccine being administered in the U.S., the number, pattern and types of adverse event reports are similar to what we see for seasonal influenza vaccine. More than 90% of adverse event reports nationwide have been classified as not serious.

Over the coming days and weeks, vaccine will become more available in a variety of settings, including health care provider offices, public clinics, retail locations, large employer settings, nursing homes, etc. People have three easy options in seeking vaccine: check the clinic locator at www.maineflu.gov, call 211, or call their health care providers.

Vaccine Recall
About 800,000 doses of H1N1 vaccine in the .25 mL pre-filled syringe presentation manufactured by Sanofi Pasteur and approved for children ages 6-35 months have been recalled due to questions of potency. This is not a safety recall.

Maine CDC notified 25 practices on Wednesday that they had received some of the recalled lots of H1N1 vaccine. The remaining vaccine from these lots was pulled from their shelves. About 4,500 doses of the recalled lots had been recently shipped to Maine, and reportedly many of those had not been administered yet. Because there were no safety concerns and the vaccine was slightly weaker than the license standards called for, there are no recommendations for the children who received the vaccine except to proceed with their second dose as would normally occur.

All children less than 10 years old should get the recommended two doses of H1N1 vaccine approximately a month apart for the optimal immune response. Therefore, children less than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine. Parents of children who received vaccine from the recalled lots do not need to take any action, other than to complete the two-dose immunization series if not already completed.

For more information http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=86326&v=article-2008


To read the complete update: http://www.maine.gov/tools/whatsnew/attach.php?id=86508&an=2

Waiting For Christmas

"Easy Look"







(Click on images to view higher-res scans.)
Source: Dell 1000 Hints - Your Hairdo, January 1958

Christmas in the Forest

Where's That Then? No 4

A trickier one, maybe, and no buses to help everyone along. Perhap's the clue to narrowing it down a bit may lie in the brewery initials up on the pub. I like that bloke with his hands in his pockets. I've got a jacket like that, and I wonder if he brought all that stuff to Quiztown in the back of the car. Talk about an Antiques Roadshow, what with the Staffordshire dog (not a clue) and the copper kettle on the roof. OK, off you go.