Math, Logic, Maternal Deaths

A set of breathless articles have recently been circulating about how women die from complications of childbirth up to a year after giving birth!

Yes, our healthcare system is a horror show; yes, many maternal deaths are and should be preventable.  However!  They occur for up to a year because that is literally how the CDC defines a childbirth-related death.  Paid parental leave would help, but 2/3 of the deaths are before delivery or within a week.  Better healthcare - and effective treatments for pre-eclampsia! - would help even more. Women don't get good information about their own postpartum health; the standard checkup is six weeks later. Black (and Latina and Native and so on) women die disproportionately, and age and education are no protection.  

I'm all for paid maternal leave, for better healthcare, for equitable treatment of all.  But I don't want people to apply parental leave as a cure-all for something caused by how the numbers are counted.

Offended by Life

So I've been having these terrible migraines twice a month for a year (every 28 days like clockwork; thanks for nothing, hormones!).

In between a million doctor's appointments I decided - probably in a (properly prescribed) drugged haze - to try a 'migraine supplement'.  One of the ones with herbs and a bunch of random B vitamins in possibly toxic doses.  (Also some enormous dose of magnesium, and I have given up drinking all alcohol, most added sugar, all painkillers, and more than one cup a day of coffee, all of which is also terrible).  The evidence is shaky!  The magnitude of the effect is... not entirely convincing!  But also one migraine lasted for five days.

My friends, I regret to inform you that it might be working.  I do not believe in herbal supplements or shaky observational studies or taking vitamins in normal, healthy adults.  But the migraines are so horrible that I think I have to... keep taking this stupid supplement?   I am deeply offended.

Maybe Not My Favorite Game

Today, my friends, I have collapsed into bed, where I am playing "Influenza Or Side Effects?" This would be a great exercise in analytical reasoning, except for the part where you only get to play it when you're not quite in your right mind! And I don't think of myself as particularly suggestible, but reading the reported side effects in prescribing information is practically guaranteed to give you at least one of them- headache if nothing else!

Anyhow, I think I'll try this particular medication again sometime... later. Possibly never.

Today I Learned:

... that the reason this year's influenza vaccine is not very effective is this:

"The egg-adapted version of this viral strain lacks the new putative glycosylation site. Here, we biochemically demonstrate that the HA antigenic site B of circulating clade 3C.2a viruses is glycosylated. We show that antibodies elicited in ferrets and humans exposed to the egg-adapted 2016–2017 H3N2 vaccine strain poorly neutralize a glycosylated clade 3C.2a H3N2 virus. Importantly, antibodies elicited in ferrets infected with the current circulating H3N2 viral strain (that possesses the glycosylation site) and humans vaccinated with baculovirus-expressed H3 antigens (that possess the glycosylation site motif) were able to efficiently recognize a glycosylated clade 3C.2a H3N2 virus."

In other words, when they grow the influenza virus in eggs, the H3N2 strain has a different surface antigen profile, and so it's a bad vaccine, and it's always going to be a bad vaccine.  Most early flu activity was influenza A/ H3N2, so thus far, the vaccine has not been especially effective.  (Overall the report is around 30% but that is across all strains; some estimates place it as 10% for H3N2. Yikes!)

(It is still better than nothing!  Our whole family got flu shots in September!  However, it's not very effective. Now what we need is robust government funding for better vaccine development... ha, ha, ha.)

Brief Update, And Mostly Useless Recipe

Ear status: better than it was, but not great.  I don't want to die any more!  But I could really go for some nice narcotics.  (Yes, I have other drugs; no, nothing is as good as narcotics.  Except maybe FIXING MY !@#$ EAR.)

Recipe: Because I live in the middle of nowhere, we are amply supplied with nature, mountains, fresh eggs, livestock, and local vegetables.  We are not amply supplied with stores.  It is not possible to buy fake-butter for baking without driving for hours. Hence: my version, made from what I can get locally or order from the internet (ALL HAIL).

Fake Butter-Flavored Earth Balance Baking Sticks Shortening (non-hydrogenated, vegan)

110 g cold water
2 T pea protein 
2 T soy lecithin

2-3 t salt

500 g unrefined coconut oil (such as Lou-Ana, Kroger brand, or whatever is handy - the kind that melts at 72 F, not 90 F)
350 g palm shortening
150 g canola oil
Optional: 1/2 dram Lor-ann artifical butter flavor or the flavoring of your choice


Mix the water with the protein and lecithin and let sit at least an hour until the lecithin is fully dissolved. Add the salt.

Melt the solid oils in the microwave or on the stove until they are at least 90% liquid.  Mix with a hand mixer or stand mixer until fully blended.  Add butter flavor if desired (it contains no dairy). While beating, pour in the water mixture slowly.

Store in a covered container in the refrigerator.  This shortening is soft at room temperature, mostly solid in the refrigerator, and melts a lot like butter.  Good for cookies, where pure coconut oil gives structural failure and pure palm oil gives a strange waxy taste.

Notes:
Any neutral-flavored liquid oil can sub for canola. I don't recommend olive oil; it gives a very strong flavor.
You could probably use soy or rice protein.  I haven't tried either.
Many co-op/organic type stores will sell soy lecithin by the ounce if you don't want a whole pound.  You can put the extra in bread dough a tablespoon or two at a time.  Sunflower or egg lecithin would also work.

Yes, Well, Plus State of Self

Here. And a sincere FUCK YOU VERY MUCH to all (edit: that is, the subset of) the white dudes and straight white Christian ladies who are convinced everything will be fine through the next four years.  People of color, religious minorities, immigrants, queer people... even some straight white Christian friends in town with black children?  We're all terrified. (Along with anyone who has sense.)

Now that we've gotten that over with.

I am in... less pain!  I have not achieved No Pain since June.  However, I have a lot of drugs now and a very expensive round of physical therapy.  It's getting better.  I feel like one day I might be Mostly Better.  Huzzah.

Today I did my first round of Terrifying Antibody Thing.  It was enlivened by a brief round of intense itching.  Friends, itching is not good when you have been injected with antibodies. However, it mostly went away.  My kind neighbor watched Sweetpea for two and a half hours while I sat about knitting, trying to not go into anaphylactic shock. Good times for all.

Next semester I have been roped into teaching something I don't really want to teach.  For Reasons.  (If I say no now, it's no forever; it pays fairly well for fairly little effort; it's actually the Science Thing I know and like the best; there is the possibility for more interesting work in the future; I know and like the person who offered me the job and therefore I have a reasonable expectation it will be okay.)  I'm a bit afraid I'm going to end up teaching forever because I'm lazy.  Yes, yes, I know: I don't have to do it if I don't want to.  But if the choices are This, Nothing, or Move, then This wins.  Is this better than nothing?  Sure, fine. 

My assortment of part-time babysitters is working out pretty well.  The kids love them, Sweetpea runs up and demands "Lap! Read book!", and everyone is in one piece when I get home.

I continue to apply for Other Jobs. (They never write, they never call.) 

I am taking an (online) class in databases from Mountain State University - it's surprisingly good, taught by someone with a deep and abiding love of the database- and predictably, writing code is the only part of it I'm actually good at.

Between my students and the election, I have a terrible headache, so I'm taking to my bed and trying again tomorrow....

Memo to Brain

Hey Brain,

Look, I know we've had a rough last.... well, about 50 days.  And I know that yes, historically speaking it has been Not Awesome to lay awake in bed, in pain, for hours every night.

But this thing with throwing a panic attack every time I lay down in bed?  Not so cool.  Yes, I know, you got all conditioned.  Please, please knock it off.

(Suggestion for how to decondition my stupid brain are welcome.)

Dispatches From Brain

Lizard Brain: "AAAAAAAH SUDAFED NOW PANIC AND FREAK OUT"
Ego: "Shh, it's okay, it's just physiology."
Lizard Brain: "BRAIN PHYSIOLOGY IS PSYCHOLOGY PAAAAAAAANIC"
Ego: "Dude, I can't work under these conditions."

Lizard Brain: "WEIRD BRUISES we're all gonna die"
Ego: "It's probably... NSAIDs plus prednisone, right?  Yeah.  It's okay."
Lizard Brain: "AAAAAAAAAAAAH"

Lizard Brain: "PAIN EVERYWHERE WHY"
Ego: "You're right.  I give the fuck up."

Where's Waldo? (Contains: Whining)

Sick.  Since... June 13.  Two rounds of steroids, three kinds of antihistamines at once, and ten days of antibiotics.  It hurts to eat.  Tonight I had scrambled eggs and gluey rice pasta for dinner.  

Anyhow.  It will get better again some day.  Today is not it. 

Always Look on the Bright Side of Life

Well! I have recently been to visit the nice doctor for, I thought, a refill of the boring asthma inhalers.  (Though not - I specified - the exciting ones.)

The nice doctor was rather concerned that I've spent so long being so ill, and the persistence of various things, and the fact that I turned up rubella-non-immune while gestating Sweetpea.  So!  Now I get to go be screened for a truly distressing array of Not Great Stuff.  And, you know, some of it is quite plausible.  This whole mess IS all outside of the normal range.

But, on the BRIGHT side, I would now be quite grateful for it to be JUST the world's worst allergies.

Static

... in all the senses.

My yard is still weedy.  The flowers are growing and are very pretty

My job is still in limbo because Outgoing Chair has not yet Outgoed.

The job I don't want has had zero qualified applicants. I am aaalllllmost tempted to apply... but I really don't want to manage conflict for a living.  (Is this better than nothing?  Probably not.)

The children are still children.  I have attempted to solve this by sending them to camp.

My health has reset itself to pre-Sweetpea levels (IRONY ALERT: discovered I was pregnant five days after that first one, though I didn't write about it for a while). It is a work in progress.  I would like to return to 'not in constant pain'.

Everything else is just going along.  Sweetpea is using baby sentences.  Everyone is getting wet and muddy on the regular (creek in middle of front yard). Dr. S has research students as usual.* I have now stayed up too late writing.


* Every humanities faculty member ever: "It must be so HELPFUL to have research students!"
Me: "Have you ever baked cookies with a three year old?  Now imagine four at once."

Maybe Later

Urgent Care Doctor: "Would you also like a steroid taper?"

Me: "I'm pretty sure taking four immune suppressants at once is what's brought me here.  So maybe not just now."

Rational Anxiety

Since I live in a small town, I rarely have to travel more than five miles to get anywhere.  (The houses of some rural friends excepted, and occasional trips to see people.) Things are generally within a few miles, or an hour away and I order it on the internet.

For a lot of reasons I am Very Anxious about driving.  Surely it's the thing most likely to kill me in an untimely fashion, right?

Naturally I went and looked it up.

The CDC keeps (of course) detailed statistics on cause of death.  In my current age group, the top causes are:

ICD Sub-Chapter	Deaths	Population	Crude Rate Per 100,000
Total	1,284,817	684,278,755	187.8
C00-C97 (Malignant neoplasms)	220,606	684,278,755	32.2
W00-X59 (Other external causes of accidental injury)	150,496	684,278,755	22.0
X60-X84 (Intentional self-harm)	105,989	684,278,755	15.5
I20-I25 (Ischaemic heart diseases)	102,158	684,278,755	14.9
V01-V99 (Transport accidents)	101,614	684,278,755	14.8
B20-B24 (Human immunodeficiency virus [HIV] disease)	58,381	684,278,755	8.5
K70-K76 (Diseases of liver)	55,410	684,278,755	8.1
I30-I51 (Other forms of heart disease)	54,753	684,278,755	8.0
X85-Y09 (Assault)	45,954	684,278,755	6.7
I60-I69 (Cerebrovascular diseases)	34,259	684,278,755	5.0
E10-E14 (Diabetes mellitus)	31,363	684,278,755	4.6
I10-I15 (Hypertensive diseases)	28,675	684,278,755	4.2
F10-F19 (Mental and behavioural disorders due to psychoactive substance use)	25,873	684,278,755	3.8

(Two thirds of the 'other external causes' are accidental drug overdoses.)

 (There are two deaths whose cause is listed as 'bitten by rat.'  I have so many questions.)

(And one death by alligator.)

I'm afraid of driving.  Since I rarely have to make long trips, for me it is an avoidable risk, so it feels like a better choice to not drive (due to some kind of cognitive bias- the one where the availability of a choice to do nothing makes it seem safer than doing something even if it's not so- incidentally one of the fallacies that leads people to not vaccinate.). I suppose my anxiety is semi-rational; the lack of regular exposure means I never get de-conditioned.

What's your irrational or semi-rational anxiety?  

Don't Read Depressing Things For Fun

Things I have, unwisely, read in the past week:

OMIM: Look at all the distressing things genetic material does!  Biased heavily towards the awful, on the grounds that there are few case reports reading 'Probable diagnosis of rare genetic syndrome, one episode of mild symptoms, otherwise fine.' (Case series excepted.)

MMWR: Look at all the distressing things infectious diseases (and sometimes acute environmentally acquired terribleness) are doing this week!  Read it and shudder, then go bleach everything!

Comment sections almost everywhere: Look at how terrible people are in the absence of social pressures to the contrary!  (I recommend Ravelry instead, where complete strangers will put themselves out to be nice to fellow humans)

Role Reversal

Otherwise Excellent Doctor to me: 'Maybe an ultrasound would be helpful.'

Me: 'Okay, but how would that information change anything we're going to DO?'

OED: '..... good point.'

Running cost of breastfeeding troubles, food not included:
ENT: $150, $40 = $190
Medical visits: $15 x6 = $90
Prescriptions: $15, $15, $50, $15 = $95
Asst. related supplies: $100

$475

Plus food.
May or may not be less expensive than formula but is NOT free. 

(It also transpires that never ending boob problems- in this case, a milk blister that will NOT go away no really no matter what, leading to blocked ducts and/or weekly nipple unblocking with sharp pointy needle, by me- can be helped by applying steroids and antibiotics [triamcinolone and mupirocin], with bandaid, four times a day.  I recommend Curad Truly Ouchless band-aids; several other varieties hurt immensely, left me with peculiar rashes, or were otherwise unsatisfactory. They are latex free; naturally, I am allergic to latex.  I leave this information for the Google Machine and the next poor soul experiencing this problem.)

Grinchiest No; Advance Directives; Also, Wakes

Someone I knew in Cold City is 'crowd funding' her parent's funeral. To the tune of $15,000.

Look, I know funerals are stupid expensive.  However!  If someone's last wish is to be cremated and transported to  [East Asian Religion] monastery in a far flung corner of [Faraway Country], perhaps that person should make those arrangements their own damn self, especially before being dead/ expensively brain dead.

And if someone's only offspring is a broke grad student with a child, maybe that's a good time to put aside sentiment - and expensive funerals.

Maybe I'll feel different about it when I'm older, but I suspect I and my robot feelings will turn out like my mom: "Bury me in the cheapest crate they have.  Or a sheet. I don't care. I'll be somewhere else, or nowhere at all, by then."

Also, if it were my ashes or even my beloved parent's ashes, I would have the crematory send them FedEx.  Live within your means!

(I'm trying to think if there's any kind of 'crowd funding' for donations -as opposed to goods and services- that I don't feel grinchy about.  Maybe 'my house caught fire'.  But only for people I actually know well, because I feel no financial obligation to relative strangers, though we do donate to charities. You?)
*****

For some reason this brings to mind the time my grandma was filling out a Five Wishes form.  She was going along checking off and crossing out.  "I want my clergy person to be notified if I am hospitalized - yes. I want to be bathed even if I am nonresponsive- yes. I want my congregation to pray for me if I'm ill - maybe.  WAIT.  'I want to be massaged daily with oils?' Fuck,  no."

*****

I recently went to a memorial service at the local country club.  'I think they'll have wine,' I told Dr. S.  'At a memorial?' he said. 'No!'

Open bar and LAKES of wine and a bluegrass band and five kinds of dessert and only 15 minutes of speeches.  Dear readers, when I go - may it be decades away - raise a glass and float me off on a lake of liquor. But only if everyone can reasonably afford it.

State of the Self, 10:30 PM, With Wine

HEADACHE: Mostly gone.  Hearing probably also 5% reduced, but I'll take that over a perpetual knife in the ear.  Let's say a 2.

F@#$ING MASTITIS: Persists as milk blister.  Imagine a blister in a sensitive area and, well, it's about as fun as that.  3.5.

WORK FRUSTRATION:  A solid 6 for reasons I will not discuss, owing to my desire to stay employed.  Also frustrating: the fact that I do not enjoy or value most of my daily work of cooking, cleaning, and general contracting secondary to subsidizing my spouse's career.  This Too Is A Phase.

CHILDREN: Continue to injure each other in appalling ways (no, I do not let them bully each other, but I cannot be constantly physically present with three children).  Latest: head slammed in door.  Ranging from 2 to 'It goes to  eleven. "

BABY: Sweet, endearing, and yet SO high maintenance.  I wonder if I will ever adapt to the reality of having a third child.  Maybe when she can walk and talk?  (Current words: DA- dog/cat/squirrel; NA NA- milk/mommy/feed me, peons).  The baby year is just so darn hard, people.

FUCKING DEPRESSED: Enjoying a renaissance thanks to Where Are My Real Friends Here, I Want R and N, WAAAAAH.  Prescription: more exercise, more free time (HA), more gardening (double ha).

NO F@#%ING STOVE: Have I mentioned I've had no stove for TWO months?  Yes.  It's kind of like going to the post office: anything involving more than a certain number of steps rapidly becomes asymptotic to 'impossible'.  Now I must visit a metal shop during business hours, procure a 36 x 2 5/8" strip, sand it, and paint it black.  This makes three stove tops, four trips to the hardware store, and three electricians.

No Free Lunch

Last week, a friend asked me what I thought of herbal remedies. (She probably regretted it almost instantly.)

While others have done an excellent job summarizing evidence, and lack thereof, about herbs, I want to reiterate what I told my friend, because I think it's the most overlooked point about 'using plants like out bloodletting ancestors who  frequently died in childbirth and of common infections':  any dose of something large enough to have an effect is a dose large enough to have a side effect.  If herbs work, it's because there's a real, bioactive component.  We call those drugs.  

Does Vaccine Hesitancy Matter?

A friend asked me this week if it really matters if other people delay vaccinating their children.  As long as their child has received at least one dose of each vaccine, they asked, isn't their own child protected?

Absolutely not!  For one, most vaccines require multiple doses for full effect; for another, even the best vaccine is not completely effective.  The current pertussis vaccine, developed because of worrisome but not dangerous reactions to the cellular vaccine, is only about 85% effective.

Let's take measles FOR EXAMPLE. Modeling - based on lots and lots of data- shows that for one, about 95% of the population needs to be vaccinated to prevent outbreaks.  Here is a particularly good REAL WORLD EXAMPLE of what happens, in a densely populated area, when this isn't the case.  You can read the whole paper for yourself, but the summary is: not twelve years ago, the Solomon Islands had a big measles outbreak.  There were only 50,000 people living on the islands and at least 800 of them caught measles.  The outbreak lasted six months.  Six months.  They finally went and re-vaccinated 35,000 people regardless of whether they'd previously been immunized.

Take that in for a minute.  They re-vaccinated 70% of the population.

"From 1989 until 2003, the RMI did not report a single case of measles, and World Health Organization (WHO) cluster surveys showed single-dose vaccine coverage of 93% and 80% among 2-year-old children in 1998 and 2001, respectively, although second-dose coverage lagged behind at 40% in both years." 

"The outbreak ended only after vaccination of ~35,000 persons among a population of 51,000." 

"[T]he reported coverage of 1-dose measles-mumps-rubella (MMR) vaccine was 80%–93%..... [Of the measles cases] (23% involved infants who were below the age of routine vaccination), 100 hospitalizations (34% involved infants), and 3 deaths. Of outbreak cases, 41% were reported to have been previously vaccinated." 

That's right! This large outbreak happened even to people who had been vaccinated. The percent of the population dropped below the protecting-everyone threshold- in part because many children did not receive their vaccines on time, especially the second dose!

Why stick to the recommended schedule?  Because in general, there have been lots and lots of studies demonstrating to test the schedule and determine what sequence gives the best immunity - while protecting children as much as possible.  In other words, vaccines are given as soon as it's been shown they'll be both safe and effective in children of that age.

Whenever someone, because they read a dumb book or heard someone on the radio or for any other not-medically-indicated reason, delays their child's vaccines, they are increasing the chances of an outbreak.  Infants are disproportionately vulnerable in outbreaks - but also even children old enough to be vaccinated are at higher risk.  They're putting your kids at risk, but they are also putting their own kids at risk.  Please, tell them.

Have you ever convinced someone to vaccinate their child in a more timely fashion? Or informed them of FACTS about vaccines?  Told them a personal story ('my cousin got pertussis and gave it to my grandma')?

(Retrospective irony alert: "In contrast, (less than) 120 measles cases have occurred annually in the United States since 1998 [2, 3]. The success of the US measles program is based on (greater than) 90% preschool vaccination coverage for 1 dose of measles vaccine and the near-universal requirement of a second dose for school entry [4–6].

Owing to Circumstances Beyond Our Control

I'm going to have to confine my remarks to things NOT having to do with my multitudinous feelings.

Item: I continue to loathe all persons asserting that science has no value or validity in their lives, and who have nonetheless not died of dental abscesses, measles, smallpox, pneumonia, or asthma.

Item: I am going to have to uninvite the anti-vaccine person from playgroup and, contrary to what people may think, I do not actually enjoy being mean.

Item: Bug has now gone to 4.5 days of school and continues to be a crazed weasel afterwards.

Item: Sweetpea almost has a nap schedule.  I usually get 90 minutes alone.  In that time I can either do yoga, make dinner, or eat lunch, but only one.  This is not ideal.

Item: Next week I return to working... all of three hours per week.

Item: I am contemplating joining the Y solely for the childcare.  Because then I might get exercise. (Many repeated  joint injuries make running inadvisable.)  This is especially trying given that I have free access to two gyms AND a set of fitness classes.  But.... childcare.

Item: The Headache of Doom continues.  I begin to wonder if perhaps I should seek medical advice.  Do you suppose they'd give me more narcotics if I ask nicely?