davealden.com: April 2009

Wednesday, April 29, 2009

The Flu... and You...

Heard anything about the flu virus? As the mass media gets you ready for bedlam and hysteria, here’s a quick primer on what you need to know.

There are literally thousands of different virus (some you’ve probably heard of before such as herpes, Norwalk, HIV, measles, rhinovirus, ebola), and they come in various shapes and sizes. Viruses infect different tissues (respiratory tract, gastrointestinal tract, skin cells), and have many different properties. I’ll try to cover some general virus background and then focus on the Influenza virus A and B, which fall under the classification of orthomyxoviruses.

First, to put it into perspective, a virus can be about 100 times smaller than a single bacterial cell, so we’re talking tinier than tiny. Viruses are actually submicroscopic.

Next, viruses are unlike any other living things because they are not living (at least not by commonly accepted standards). Viruses are simply strings of proteins that are designed to hijack living cells—the ONLY way viruses can be active is if they invade other living cells (be that of a plant, an animal or bacteria). Viruses contain either DNA or RNA, (yep, genetic material), a protein covering, and some are also enclosed in a layer of lipoproteins called an envelope. The envelope is somewhat similar to the lipid bilayer membrane that encloses human cells. In fact, it’s that similarity that allows an enveloped virus to fuse to a human cell to initiate the hijacking process. Influenza A and B are both enveloped RNA viruses, which does mean they do have some ease in infecting human cells, but that envelope is also fairly fragile—good cleaning practices should be able to “kill” the virus.

The envelope also helps in the identification of the different influenza strains as they have special “spikes” (surface glycoproteins) called hemagglutin and neuraminidase. Hemagglutin binds to the surface of human cells to start the infection process, while neuraminidase acts as an enzyme to break down the protective layer of mucus we have in our respiratory tract (decreasing our defenses), and it breaks open the surface of the infected cell after the virus has replicated to help it spread to other cells. When you hear flu strains described as H1N1 or H5N1, that’s classifying the virus on properties of the hemagglutin and neuraminidase.

Properties of the RNA allow for classifying the virus as Influenza A or B. Influenza A has different strains that infect other animals including birds, swine and horses. Influenza B is primarily a human virus. The ability of a virus to infect certain species is based on its hemagglutin and the blueprint to produce different types of hemagglutin is carried in the RNA.

Every time a flu virus replicates, it has the opportunity to mutate. Some of these mutations and changes are small—called antigenic drifts, and some are major—called antigenic shifts.

The scary mutations—one that we may be seeing now—are when RNA segments of different species’ strains combine to form a new virus that human cells may have never faced before because the virus previously lacked the ability to infiltrate human cells.

Antibodies (the body’s good guys) against hemagglutin, prevent infection (remember, thats what helps the virus envelope bind to human cells) and antibodies against neuraminidase help prevent the spread of the infection from cell to cell (remember, neuraminidase helps the virus break out of the infected cell after it has replicated).

Flu vaccines are designed on what’s predicted as the upcoming strain, based on epidemiologic studies of worldwide infections. The keyword here is “predicted.” Vaccine makers don’t know exactly what strain will be prevalent, and mutations can (and do) occur faster than vaccines can be formulated, produced in mass quantities, distributed world-wide and administered to billions of people.

Transmission is typically by inhaling respiratory droplets from an infected person who has coughed or sneezed. If infected with a regular Influenza A strain, symptoms usually appears within 24-48 hours and include sore throat, cough, headache, fevers, and significant muscle pain. Gastrointestinal symptoms are rare for Influenza A and B infections. A flu infection may be hard to differentiate from other types of infections (bacterial pneumonia for example), but pneumonia is diagnosed with specific findings on chest X-rays, and the flu symptoms typically hit hard and fast, especially the fever and muscle aches. Viral swabs are available for diagnostic testing however.

As with most viral infections, treatment usually is supportive, meaning targeted at the symptoms (treating pain and coughing, etc), because there is no way to CURE the flu.

Zanamavir (Relenza) and oseltamivir (Tamiflu) are in a class of medications called neuraminidase inhibitors. They don’t work on the viruses themselves, but they prevent further spread of the virus from cell to cell (only within the infected person). These neuraminidase inhibitors are reportedly effective against both influenza A and B, and while not technically curative, they reduce the duration of symptoms for a couple of days but only if treatment is started within 48hrs of onset of symptoms.

Wikipedia has a great, up to date, page on the current situation with the emerging swine flu: http://en.wikipedia.org/wiki/2009_swine_flu_outbreak

Also, check out:

* http://www.mass.gov/dph/swineflu
* http://en.wikipedia.org/wiki/Orthomyxovirus
* http://en.wikipedia.org/wiki/Flu_pandemic
* http://www.cdc.gov/flu/weekly/

The bottom line is that infection is preventable with simple, basic hygeine. Wash your hands and avoid close contact with sick people. I can do the first thing... but not the second!

Friday, April 24, 2009

Orlando!

So, as I mentioned in my Hawaii post, I also went to Florida this spring. As you may or may not know, I lived in Orlando for a few years, and to be honest, I don't miss it. However, my mother is down there, so I went to spend some time with the Mom, AND I brought my bike so I could get some early season riding in, AND there happened to be a PA conference that I could go to so I actually got to do a little learning while I was down there. Not bad, huh.

Overall, the trip was good. I did some rides:

Note, I didn't set any speed or distance records, but I was on a 29'er mtb with only 1x8 gearing and slick tires... it was just good to be out!

I took some photos:

And among other things, I helped my mom get some cleaning done.

Unfortunately, I also got mauled by a Rotweiller. Alright, not really mauled, but definitely maimed. Well, I guess it wasn't even a maiming, but I did get a good little nip on the arm and I got feel like a patient while I went to an ED for an rx for Augmentin. I definitely prefer being on the listening end of the stethescope, if you know what I mean. If you don't know what I mean, well, I'm tryng to say that I'd rather do the auscultation rather than be auscultated. Not that auscultation in itself is in any way painful or uncomfortable, In fact, it's more benign than palpation, which can in fact be painful to the palpee. Or,would that be a palpatee? And is that some sort of relative to the manatee?

Anyway, I digress.... and digressing may have been what caused this SUV to flip. Who knows...

After days of running and riding in Hawaii then Florida, it was quite a bummer to come home to weeks more of cold rain...

Saturday, April 18, 2009

Dangerous Hawaii!!!

Maui--Saturday February 28, 2009

Wow. We couldn't believe that our vacation was over already. Saturday was kind of a bummer of a day because we had lots of time before our flight, but then again, we didn't really have enough time to have an adventure. So, we spent our morning wrapping up the packing, doing some errands (yep, I found a Super Cuts on Maui), having lunch at the health food store and snapping some last minute pics. We also had a great dinner in Makawao at a restaurant called Casanova's. Mmmmm!

The flight home was VERY different from the flight TO Maui. It seems much more crampe

d, much longer, and just overall uncomfortable. I didn't any sleep to speak of and we landed, grabbed our luggage, hopped on a shuttle to the parking lot, immediately drove to Ipswich to pick up the dogs, got home, threw our stuff on the floor and crashed. Work the next morning was a little rough.

All in all, it was an awesome trip. Believe it or not, I took off for Florida the next week after this, but more on that later.

Venus and the moon...

Go back to the first Hawaii post to start from the beginning!

Maui--Friday, February 27, 2009

One of the big attractions on the island of Maui is catching sunrise from the top of Mt. Haleakala. The island's mountain slopes and ocean winds cause the area near the top of Mt. Haleakala to be shrouded in clouds, but the peak itself rises above the top, so in sunrise, you get to see the sun poke up through the clouds while you look down. From the photos we had seen, it was pretty cool. The first risk however is that sometimes the top of the volcano is covered as well and the sunrise is a dud. The second risk is not getting to the top in time. Most people make an attempt to catch sunrise early in their stays, so if it's a dud, they can re-try, and some people start the journey at 4am. Well,

Jean and I are NOT most people. We waited until our second to last day, and we waited until the last second to get out the door. I'll take the blame on the latter part, as I underestimated the drive time. I forget what time exactly we left, but I do remember seeing that early morning glow get brighter and brighter, and still thinking of how far we had to go. The road up the volcano is narrow, winding, and sometimes treacherous, but I was not about to miss a photo-op. We passed the gate (the volcano is in a national park) and didn't get optimistic information from the ranger in regards to our estimated drive time and the predicted time of sunrise, but still, we kept driving up. And up, and up. We pulled in to the parking lot at the top of the volcano (which, incidentally, it's weird to write a sentence that includes the words "parking lot at the top of the volcano") and leapt out of the car just in time to hear the crowd of people (maybe 100 or more, many wrapped in blankets) grumble about the fact that the sunrise was late. What luck! We had enough

time to turn the cameras on and start snapping away... yeah! The sun rise was VERY cool! With that item checked off on our list, we jumped back in our ride and made our way back down the volcano. Jean had an appointment with the spa, and I had an appointment with some mountain bike trails.

I went to Poli Poli state park which was on the slopes of Mt. Haleakala, and this area appeared to the best (if only) mountain biking on the island. Now, as far as mountain biking goes, I'm pretty committed to this whole singlespeed movement. I'll allow myself gears on my road/commuter bikes, and my cyclocross bike (for now), but for mountain biking, one gear is the way to go. The bike I had with me in Hawaii was geared though, with a 1x8 gearing. I allow this because the bike truly is multi-purpose (road, off-road, touring, commuting). It didn't really matter because soon enough, it was a de facto single speed--I dropped it into the largest cog and just started climbing. I only got up to about 8000ft, about 2000ft shy of the volcano's peak. I really had wanted to get to the top, but I really didn't know how far I had to go, and I just kept pedaling and pedaling

and pedaling, hoping to be able to see the peak to guage the distance. Every turn in the trail gave me another spot to say to myself "I'll just get to that next turn...". Eventually, I was starting to get a little tired (i.e., out of shape), and whipped out the GPS to see what my elevation was, knowning that my goal was about 10,050. When it said that I was only at about 8,250 I decided to turn around. Am I weak? Yeah, sadly, I'd say I am. Although, 3,000ft of climbing on a 30+lb in February was still a great work out.

With the rigid cromoly fork on the front, I think I got more of a work out on the way down though. Ouch. I do love the hardtail, but give me some front wheel travel. Anyway, on the way down, I took some of the side trails for some singletrack bliss. All in all, this day of riding was worth bringing the bike.

I made my way back to the rental car and then made my way back down the twisty road to the state park.

In retrospect, I did LOTS of up and down switchback driving--first UP to the top of Mt. Haleakala, then back down Mt. Haleakala to Makawao, then up the twisty road to the cottage, then back down the twisty road to Makawao, then up the twisty road to Poli Poli state park, then back down that same road, then back up to the cottage, then back to Makawao and over to Kihei, then back up to the cottage... Oy!

Kihei? Yeah, we went for sushi again. That killer sushi restaurant, Sansei Seafoo d Restaurant and Sushi Ba r had two Maui locations so we figured we'd try a different one. Bad idea. We waited nearly an hour after placing our order to get our food, and it wasn't worth the wait. We were very disappointed, but it's better than a chop stick in the eye.

Anyway, once back at our cottage, sadly it was time to start the bike disassembly and time to start packing.

Mahui--Thursday, February 26, 2009

We woke up to more rain, but we decided to take a shot at getting some hiking in, as the weather was often vastly different just a short drive away. We packed clothes for various climates and headed down the winding road and across the isthmus to West Maui for more whale viewing and hiking on the Lahaina Pali Trail trail. This was a great trail, but wow, was it windy. And I don’t mean a little breezy, I mean 40+ mph gusts, enough to actually push you off balance. Jean was clinging to rocks as times (fortunately, my mass kept me a little more stable

).

After our hike there, we made our way back to Kahului for lunch at a great health food store, Down to Earth, then it was back to more hiking, or so we thought. We went to the Iao Valley State Park to see the Needle, a rocky prominence we later learned was felt to be a phallic symbol, however, we were disappointed to learn that the only "hiking" was 0.6 mile paved loop. Bummer. We still went, took our obligatory photos, and also walked around another nearby garden.

Now, truth be told, I'm writing the actual text of this post almost two months after the fact, and I'm going off of: