Blogathon Blues

I knew when I signed up for the blogathon it would present problems, particularly since I had registered for the Kachemak Bay Writer’s Conference June 14-18 and I was getting a late start on the garden. I was not expecting to:

Cambridge brick sidewalks. These are in better repair than those where I fell. tripping on an asphalt patch that was actually a curb.

(1) sprain my wrist when I tripped and fell on a Cambridge sidewalk a week ago, or

(2) have a Doctor’s appointment made Monday to talk about what I thought was a minor but annoying problem balloon over two days into a projected operation in Anchorage, 350 miles away.

I normally blog four days a week: Monday (Alaska weather), Wednesday (quotation contexts), Friday (Jarn’s Journal ) and Sunday (snippets from my writing.) I thought I’d fill in Saturdays with my genealogy from Genographics, and  Tuesdays and Thursdays with my experiences at the conference and in self publishing. Well, I’ve had to cancel the conference (I’ll be in surgery when it opens, and the surgery has nothing to do with my fall in Cambridge.)

I don’t know yet if I’ll have WiFi in the hospital, but the Wednesday and Sunday posts for June are already scheduled. I hope to get next week’s and Jarn’s Journal through the end of the month written and scheduled before I fly to Anchorage Tuesday. Beyond that? I have just had my collection of old slides digitized and I have lots of other photos from the Corning Glass Museum, so you may be treated to a lot of pictures on Tuesdays and Thursdays. But I’m still going to try for a post a day.

Vitamin D

I know. You’re supposed to get your vitamins and minerals from your food, rather than pills.

But ….

I live in Alaska. The only time I can get really fresh produce is in summer, from my own garden and the farmers’ market. The rest (most) of the year I have to get “fresh” produce that has traveled a loooong way, or frozen food. Being lazy (and suspecting that the frozen stuff may actually be more nutritious than the “fresh” food by the time it gets here) I all too often stick a frozen dinner in the microwave. I doubt seriously that I am getting all the vitamins and minerals I need in my food, so I take a variety of supplements.

Some are subject to a good deal of controversy; some, like Vitamin A, can actually be toxic in large quantities. But I got a surprise on one recently: Vitamin D.

Vitamin D is one that most people can make for themselves if they get enough sunshine on bare skin. Without sunblock. There are foods that have Vitamin D naturally, notably fish and the marine mammals that eat them. This is why the native population, eating a subsistence diet, can survive in Alaska. Believe me, we don’t get much sun on bare skin. Even at the height of summer the sun doesn’t get very high in the sky — about 45°, where I live.

I figured this out years ago. Problem was, at that time vitamin D as a supplement by itself was extremely hard to find. Most often it was combined with vitamin A, as in cod liver oil. Since I eat a lot of carrots I get plenty of vitamin A, and I didn’t want to risk toxicity by taking more — but you wouldn’t believe how hard it was to find vitamin D by itself in those days. I finally found one store that carried it — and it went out of business. Then GNC opened a branch in Fairbanks, and I was able to get vitamin D from them. But the recommended dose was still just enough to prevent rickets.

Now all at once, or so it seems to me, vitamin D is being touted as a miracle pill, needed by the body for a lot of things never heard of in my day. I just knew I wasn’t getting much sunlight, and the light skin of people who’d lived many generations in northern climates was hard to make sense of unless vitamin D was pretty important. But I was still a little worried that my 2000 units a day (possible now without a handful of pills) might be too much.

Apparently it’s not.

Last week I went to the cancer doctor for a follow-up on my breast cancer. The check-up went fine, but he’s had me on Femara for about 4 years now. Apparently one of the possible side effects is reducing bone density, so I got a bone density scan and a blood test of vitamin D (important in keeping bone strong) as part of the check-up. I’ve been taking 2000 units of vitamin D a day for several years now, so I thought my blood vitamin D would be normal to high.

The bone density was a little low, but no lower than it was two years ago. Vitamin D — would you believe at the lowest end of normal? I was actually advised to increase my dose to 4000 units a day, and keep up the calcium supplements and the yogurt and cottage cheese that are a normal part of my diet. So this seems to be a supplement that is needed. Especially for us older folks.

Diet Sleuth: A Useful Meal Planning Tool

Last Thursday’s lunch

One of the problems in carbohydrate counting is figuring out how many grams of carbohydrate are in any given meal. I explained last week how I weigh my food whenever possible. But to get from that to the number of grams of carbohydrate, protein and fat are in a meal, I use a program called Diet Sleuth. This is a program designed for Mac, though a Windows version is available. There are things that have me screaming at it, but I’d have a much harder time controlling my diabetes without it.

The first figure is the main window, with my lunch for last Wednesday selected. (To enlarge the image, click on it.) Double clicking on a food brings up a window to add the food to a meal, with a variety of

Entry window for adding a food not in the database

serving sizes or number of grams. I use grams to enter except for the cherries. Since they are pretty uniform in size and one cherry is one of the portion sizes given, I just fill in the number of cherries (10 in this case) and let the program calculate the grams.

The program comes with a large database of foods, based on the USDA database of nutrients. It also has a number of prepared foods, including frozen dinners, fast foods, and snacks. You can easily add any packaged food with a nutrition label. The second figure shows the window for adding a food, filled in.

You can also add recipes. This is particularly useful when you make a large quantity of something and freeze it in serving-size portions. The cookie recipe shown comes up per cookie, but it’s impossible to make every cookie the same, so I go by grams when I’m actually eating one. The only ingredient not in the

Florentine cookies, showing window for adding a recipe.

included food database was the candied orange peel, which I added from the package. (By the way, these cookies store very well in the freezer, and I’ll probably make a larger batch next Christmas when candied orange peel is again available. But I rarely eat more than one at a time.)

Problems? Loss of data when I change versions or upgrade my operating system! This is a real problem with added food items and recipes. (It is also the reason I do not guarantee that the version shown is the latest.) There is also a minor bug that puts the “duplicate” button in the middle of the expanded data entry window instead of at the bottom with the other buttons, but I didn’t even know that one existed until I was trying to capture the windows for this blog.

There is another problem that comes up with using any nutrition database: all fruits of the same kind, for instance, are not equal. Take an apple, for instance. Apples vary enormously in sweetness and carbohydrate content per gram. They also vary a great deal by size, if you want to use the “per apple” option rather than per gram. The sizes given don’t often agree with what’s available in the supermarket. That can be addressed by using grams, but the sweetness cannot. Neither can bones in meat.

All in all I’d recommend it as an excellent meal planning tool. You can even use it to keep track of your weight. Just don’t count on it for saving your recipes!

It’s Award Time Again

I received two awards last week: The Kreativ Blogger from Chris Kelworth at the Kelworth Files, and the Liebster from Cindy Brown at Everyday Underwear. I’m a bit conflicted about these awards. On the one hand, I appreciate receiving them, and I have no problem thanking the bloggers and linking back to them. On the other hand, both are the type that say “pass it on to x number of other bloggers”, and I know too much about exponential functions not to be aware that this is another version of chain letters, Ponzi schemes, population growth, or the failure to recognize limits in economic theory. (Yes, they all depend on exponentials, or rather on most people not understanding how exponentials work.)

I am not going to post another chart showing how many iterations of these awards it would take to reach the entire population of the world. I’ve already done that for awards passed on to five, seven, and eleven other blogs. And I’m going to follow my own advice on the Liebster: since this is the second time I received it, I’m not passing it on.

The Kreativ is also a “Pass it on to seven others” award. I will confine myself to passing it on to one which I really like, but I will follow the other conditions. The first, thank and link back to the awarding blog, as I’ve done above.

2. Answer the seven questions or alternatives. (I’ll provide some alternatives.)

3. Provide 10 random factoids about yourself.

4. Pass on to 7 others? Nope. See above on exponentials. I will, however, pass it on to one I like, and leave it to her to pass it on to seven if she wishes.

The Seven Questions:

1. What’s your favorite song? My alternative, Who are your favorite vocal artists? That one I can answer: Sarah Brightman and Andrea Bocceli.

2. What’s your favorite dessert? Unfair to ask a diabetic, but now and then I have a chocolate cocoanut crème brulee from Wolf Run. My alternative, What’s your favorite comfort food?

3. What do you do when you’re upset? My alternative: what sort of thing upsets you? Actually I don’t get upset easily now that I’m retired—except about politics and the way the world is going, which when you really think about it ought to upset anyone.

4. What is your favorite pet? I’ll have to use past tense, because when my last Sheltie died of old age I reluctantly decided that at my age and with poor balance, I really shouldn’t try to replace him. But the one that really was my heart dog was my first, Derry. He was a singleton Sheltie who I really think never figured out that he was a dog, and there’s a post about him in his puppy days on my Sheltie site. He was my first tracking dog, had titles in three activities in two countries, and I really ought to write more about him. My alternative: what do you look for in a pet?

5. Which do you prefer, black or white? The alternative given was do you prefer white or wheat bread? I’ll go a step farther in my alternative, and say what kind of bread do you prefer? Not white or wheat bought in the store! When I eat bread, it’s what I bake myself in the bread machine – apricot-almond and ricotta cheese being my two top favorites. Or Brioche bread. Blue corn bread with sunflower seeds and ancient seed bread are pretty good, too. Maybe I should post some recipes?

6. What is your biggest fear? Blindness. At the time of my retirement, diabetic retinopathy had left me blind in one eye, and the treatments had left my other eye such that I see a straight line as wavy. It seems to be fixed now except for limited peripheral vision, but I’m still worried. The alternate given was name one of your strong points or special skills.

7. What is your attitude mostly? I’d have to say laid back, I guess. Definitely not outgoing or sociable, I’m quite happy to be left alone, and downright uncomfortable in a crowd—though that’s partly due to my vision. The alternative given was Do you think it is better to help people or leave them alone?

Finally, 10 random factoids:

1. I can’t find shoes that fit.

2. I am perfectly happy living by myself. I’ve lived by myself since my second year of college.

3. However, there are times a third hand would be useful.

4. I remember (vaguely) the election of Truman.

5. When I went to junior high, girls had to take a semester of sewing and one of cooking. Boys had to take shop. I envied the boys. In retrospect, shop would have been more useful. I didn’t learn anything in sewing or cooking I hadn’t already learned from my mother.

6. I’ve lived in Alaska for almost 50 years.

7. My first home computer was a KayPro running CP/M and relying on two (literally) floppy discs, one for system and program and one for files.

8. I learned to code FORTRAN on punched cards long before the KayPro. Dropping a deck of 1000 cards was a disaster!

9. I live on a dirt road, with my own well and septic system.

10. I wish I had a dog that would alert to low blood sugar. Which leads into the one blog I plan to pass the Kreativ award on to: Sarah at Animals Help Heal. I love her post about seeing eye horses.

Meals with Diabetes

It would really be nice just to eat what I want, or even just to eat what was good for me. But when you’re using an insulin pump with carbohydrate counting, things are never that simple.

The scale was tared for the weight of the pan; only the asparagus is weighed. This is only 6 grams of carbohydrate; asparagus is not a high-carbohydrate food.

Carbohydrate counting is a relatively complex way to handle the interplay between food and insulin. The simplest way, which is what the doctors started me on 40 years ago, was a rigid diet (the diabetic exchange diet) and an equally rigid schedule of insulin shots. It worked all right during the honeymoon phase, but few people stick to it, and by 10 years ago it wasn’t working. Even when I tried counting carbohydrates to get a more accurate food intake, the intake being dictated by my doctor, I still had problems. Sometimes I would go into shock at the most unexpected times (including while eating); at other times I would go high for no apparent reason.

It wasn’t until I got an insulin pump that I learned the most important lesson of carbohydrate counting: you adjust your insulin to what you are eating, your measured blood sugar at mealtime, and how your body reacts. Some doctors are still not comfortable with this.

The standard method of carbohydrate counting just counts the grams of carbohydrate in a meal, leaving the fat and protein to themselves except for avoiding too much fat and making sure there is enough protein. This works as long as each meal contains about the same balance of fat, carbohydrate and protein. When this balance varies, it’s better to use a complex formula that includes all three, as all eventually show up as glucose in the blood. One formula I’ve seen is grams of carbohydrate plus half the grams of protein plus one-fourth the grams of fat. I use grams of carbohydrate plus half the grams of protein, unless fat makes up more than 40% of the meal. (Not often.)

But how do you get those grams?

If you’re eating prepared food you read the nutrition label. These are actually available online for many national restaurant chains, though it means going online before you go out to eat, or order it sent. (It may also shock you at the amount of fat present.) If you are eating out other than at a national chain, you have to guess – and check your blood sugar often after eating. If you are cooking with fresh food at home, you need to weigh everything and refer to some kind of list, such as the one put out by the FDA, which has nutritional information for all kinds of foods. (The FDA list is available as an iPhone app, and there are may other food listings of this sort online.) Needless to say, this greatly slows down the process of preparing a meal, which is why I tend to rely rather heavily on frozen meals – reading the nutrition labels before I buy!

As to how to weigh food, the ideal is a gram scale, usually digital and battery-powered. Mine’s almost worn out from use, but it’s an essential part of food preparation for me.

As to getting all those weights into a meal, I use a computer program called Diet Sleuth, though it means running back and forth between the kitchen and the computer room to enter the foods I’m going to eat. Next week I’ll describe how it works.

Weight Gain

“Calories in – calories spent = weight gain.” Sounds simple and rather obvious – conservation of energy, right? But as applied, it makes some rather bad assumptions. And as many will testify, it doesn’t seem to work.

To start with, caloric input is NOT the same as the calories you eat. To some extent this is recognized. Cardboard has calories, but there is no way a human body can use them. While fiber (cellulose or soluble fiber) is often excluded from calorie counts, even digestible calories may not always be digested. The true caloric input is the calories your body is able to turn into glucose and lipids in your blood stream. I suspect that people vary quite a lot in how efficient their digestive systems are, and that may even vary with time for the same person. Certainly variation with time could help explain the “set point” for body weight.

Inefficiency in our digestive system? There are digestible calories in what comes out the other end, and not just in diabetics who lose sugar in the urine. Pigs and dogs scavenge human feces, among other things, if given a chance. It is the difference in calories between what we eat and what comes out that is the important energy input, and there has been very little study of how much that form of energy out might vary.

Then there is energy usage. Certainly exercise, even walking, burns more calories than simply sitting. But it takes energy to keep our body temperature up, our heart beating, our lungs expanding and contracting, and especially to keep those big brains operating. Sitting as quietly as you can in a cool room may burn a good many calories, though I wouldn’t recommend it as a way to lose weight. (It is, however, recognized as one of the reasons people working in the cold may need more calories. If your body is very efficient at all these “housekeeping” tasks (low basal metabolism) you may need fewer calories to maintain constant weight than someone whose basal metabolism is higher.

For that matter, some people may use their bodies in exercising more efficiently than others.

I strongly suspect this is an oversimplification of what seems to be a near-epidemic of excess weight. I certainly wouldn’t argue with the idea that something in our environment (including our food environment) is tinkering with the efficiency of our digestive processes, though I suspect serving size has a lot to do with it. But why don’t we ever consider calories out? It would be simple enough in test animals, if not in humans.

Kharfun Syndrome — an Invented Disease

Ever invented a disease?

I did, for my science fiction.

It’s called Kharfun Syndrome, and it plays a large role in the history of the Confederation. It first arose among Humans, for whom it was a flu-like but usually survivable disease. Many children got it, developed immunity, and went on to lead normal lives. But it became endemic in the Human population.

The early symptoms are mild – aches and pains, some muscle twitches – and that was as far as it got with a good functioning immune system. For those whose immune systems could not handle it, the virus gradually attacked the peripheral motor nerves, leading to violent muscle cramps which was followed by paralysis, and eventual death from respiratory paralysis. The peripheral sensory nerves were also involved during the active phase, with pain spreading inward from the fingers and toes.

The Human immune system, which is basically chemical in nature, could handle the virus. I’m not going to go into the full immune system here, and in fact there’s a lot we don’t know about it. But there are times when it goes wrong and attacks something it shouldn’t. Like the Islets of Langerhans in my pancreas (which is why I have type 1 diabetes) or the myelin sheaths of my sister’s nerves (Multiple Sclerosis.) Perhaps because of this the R’il’nai, who have a suite of esper abilities and could actually perceive bacteria and viruses and remove them without even being consciously aware of the process, developed an immune system based on esper, and the old-chemical-based system, while still present, became very inefficient.

The problem with Kharfun was that the virus causing it had evolved an ability to hide from esper perception.

As a result, Kharfun was originally 100% lethal to those whose immune systems relied on esper – all pure R’il’nai, and most of the hybrids with a large fraction of active R’il’nian genes. A method of reactivating the old, chemical-based immune system was developed after the disease spread from Humans to R’il’nai, but by that time a large fraction of the R’il’nai had died.

The disease had another effect on the R’il’nai – it reduced their already low fertility. They didn’t have a high birth rate to start with – R’il’nian females were fertile for a few hours a century. (They were usually receptive, but not fertile.) And the immunization had the same effect as the disease on fertility.

So 10,000 years after the initial epidemic, the R’il’nai are nearly extinct. This was the premise behind Homecoming (where Kharfun Syndrome plays a major role) and the society that led to Tourist Trap and the trilogy I’m working on.

R’il’nian Teeth

My science fiction is based on two species, the R’il’nai and Humans, and their crossbreds, the Ril’noids, living together. One of the major differences between the two parent species is in life span. The Humans have what we would consider a normal life span. The R’il’nai, while not immortal, do not age beyond maturity. A number of my characters have been alive for millennia. Crossbreds can show either pattern.

This leads to all kinds of interesting situations in the society. How do the two species interact, for instance? How many Humans would want to marry someone who would never grow old? How does a R’il’nian act toward someone he or she knows will grow old and die while the R’il’nian is still young? This is in the background of all of my plots.

Here, however, I am addressing a different problem.

Most of the cells in our bodies are constantly turning over. I can imagine a creature that looks and acts human with a near-infinite life span, except for one thing. Teeth.

Tooth enamel wears, and unlike skin, it is not constantly replaced from within. Modern dentistry can do a lot to repair wear, but I’m having to have enamel repairs already. Young mammals are born with two sets of tooth buds, one that grows into teeth suited for the small jaw of a juvenile; the second set adult sized, and that’s it. People who lived thousands of years would wear out their teeth. How to handle the problem?

The R’il’nai would have to have an essentially infinite number of replacement teeth. When a tooth was worn out, it would be shed much as a child sheds its milk teeth, and replaced by a new tooth. How? They must have some tooth stem cells in their jaws, just as we have blood stem cells in our bone marrow. Assuming that a tooth would last for 50 or 60 years, this would mean that the R’il’nai and non-aging R’il’noids are teething roughly every two or three years. I don’t think I’ve actually mentioned that, but if a R’il’noid seems to be in a particularly bad humor, he or she may be teething.

Guest Blog #IAN

A very quick note. I have a guest blog up on But What Are They Eating about some of the foods my characters eat–and why those using esper talents must eat so much to avoid low blood sugar.

Award and Medicare

Well, I’ve had a couple of good days. First was the email Thursday that Tourist Trap was a finalist in the Reader Views Literary Awards. Yes, that’s the same one Homecoming received last year.

Then I got a phone call from the clinic saying the box of replacement sets had arrived, and I picked them up Friday, thus ending a very nervous couple of weeks.

Replacement sets?

The other end of that plastic cord feeds into me.

I use an insulin pump. It’s about the size of a small stack of business cards, and it normally lives in my pocket. It contains a reservoir of insulin, which theoretically should be changed every three days. (I normally average about six, because that’s how long a full reservoir lasts me, and I have yet to see any drop in effectiveness after six days at body temperature.) The pump gradually pushes that insulin out very fine tubing a couple of feet long to a set, which is fastened to my body by a piece of adhesive and has a fine Teflon cannula piercing my skin and delivering insulin into the subcutaneous tissue. The set has a needle which is used to insert the cannula under the skin, and is then removed. The set has to be changed every three days – any longer than that in the skin, and scar tissue starts to build up and insulin no longer gets through. These sets are not reusable; in fact they become medical waste.

I’m lucky to have very good supplemental insurance as well as Medicare, and every 3 months I get shipped 30 sets. A couple of weeks ago the shipping company called me to check how many sets I had.

“Two. When are you going to ship them?”

“We did, a couple of weeks ago.”

I have them ship to my doctor’s office, because in my experience mail order pharmacies never adequately package temperature-sensitive medications being shipped to regions where 40-below temperatures are common, and in some shipments I get continuous glucose sensors which must not be frozen. So I called the clinic, which usually calls me when a package arrives for me.

They couldn’t find the box.

By that time the pharmacy was closed, so when I called back the next morning I got the details of the shipment. They insisted it had been signed for at the clinic and gave me the exact time and date of delivery.

I called the clinic back. I think it took about a day before they finally said that yes, they had received the box. The person who signed for it remembered it. So did several staff members. But they couldn’t find it, and they’d looked everywhere. They said they’d call the mail-order pharmacy back and pay for a replacement shipment. (This is stuff no local pharmacy carries.)

The mail order pharmacy said that Medicare rules did not allow them to send out a replacement shipment – never mind that it was the clinic, not me, that verified I had never received the sets that are essential to my life, or that the clinic was willing to pay for the replacement shipment.

The clinic combed the offices of the doctors that treat diabetes, and managed to come up with a few sets to tide me over. They also called the pump (and set) manufacturer. The manufacturer FedExed me a few more sets. Finally, Thursday, the clinic called and said they had the sets from the manufacturer, and I picked them up yesterday.

I realize that Medicare does have a huge fraud problem. But in this case the clinic was offering to pay for the lost shipment, so what kind of fraud did they think was involved? It’s not as if the sets were valuable to anyone else, but they are life or death to me.