Trimethylxanthine

I run on coffee. It’s been that way since the 90s, when I realised, nine days before deadline, that the only hard drive with my Thesis had just taught me a valuable lesson about backups.

My main trimethylxanthine delivery devices are a drip maker and a Nespresso Pod machine. The drip maker is much cheaper, but doesn’t really function for just one cup, leading to my drinking cold or microwaved coffee as the day moves on.

Pods are expensive. Funnily enough, it turns out that they aren’t that bad for the environment, but that does little to assuage my guilt over having just spent 3.95€ for 50g of coffee in compostable capsules.

Which brings us to Cyprus Post who, probably because of the Winter Break, are much better organised this week, meaning I was just able to pick up my (ordered in October) Evergreen Capsules. Those things, also known as “the only time Facebook ads worked on Mikka,” combine pod amounts of coffee with cheaper forms of bean purchase.

At 18€ for the capsule, I’ll have to drink about 120 cups to make up for the expense, so in late February, should they not die until then, I’ll have my money’s worth from them.

We’ll probably do a blind test between the Evergreen and the Intenso Bio Compostable capsules in a few weeks, when everyone’s back from the winter holidays.

Pushups

It’s customary to break one’s NYE resolutions around January 19. Seriously, there’s research on this. I am determined to stick to one of them at the very least: my +1 pushup challenge.

For the uninitiated, the +1 challenge started in Iceland in 2013, when a number of medical students, home for Christmas from their semester in Copenhagen, decided to challenge each other to a little contest: for the next year, they’d do one additional pushup every day. For every month, there was one break allowed, so one break in January, twelve in December. On Dec 31, they’d do 400 together instead of the 375 pushups they’d have to do.

A clever company (not linking them) started selling calendars with the number of pushups printed into each day and a handy checkbox to mark off the day. The latter actually makes sense: accomplishments acknowledged are much better for the brain than those simply performed. A small task like a reward or simply a checkmark can help tremendously to reinforce the habit.

But since I am a bit of a nerd, I wanted something more: make my phone do the calculation work for me. Luckily there’s Shortcuts for iOS (comes standard) and even an imbecile like me can do this.

Seriously, this is about the simplest thing to use Shortcuts for, still it shows something important: most people don’t use Shortcuts, despite there being a vast ecosystem of amazing shortcuts and it making your phone so much more productive. Maybe that’s another resolution for 2021: get more in touch with the inner nerd.

If you still want mine, it’s here (needs to be opened on a phone or iPad).

Next up, I added it to Siri, made it tell me how much I had to do that day, and I was all set.


Part two of this is more involved: I want to track, how this ever-increasing amount of pushups influences my blood glucose levels, sleep, muscle soreness, muscle mass, and weight/body composition. For this, I am using three things: a Freestyle Libre to monitor my blood glucose, a Withings connected scale and blood pressure monitor (to get HRV), and my Apple Watch (also for sleep, HRV, etc.).

This will be a topic for a March post, when some data is available.

Facebook > Blogs (or: how Automattic murdered Blogs)

I have a theory why Facebook (and Twitter to some extent) beat out blogs, and it’s Automattic’s fault.

I am working on my “year in review” blog post, which uses a lot of life-logging and quantified self stuff. In the process of doing so, I found myself wondering where all those blog posts had gone…

Blogs used to be reverse chronological. Everywhere. You’d pop onto someone’s weblog start page and there they were: their posts, latest on top, ready for reading. No clicks required[1], just read.

Today’s blogs are anything but. Masonry sorted by an arbitrary “popular” ideal, massive “Hero” banners leading down a rabbit hole of SEO optimised pages, no chance at just going there and reading. Funnily enough, if you’d ask people which blogs they still visit (rather than following them on Facebook and clicking through), Daring Fireball, Marco Arment’s blog, or Bekah, are mentioned pretty often. All three still employ the old reverse chronological approach.

It’s not just good for the reader, though. Google’s indexes do still respect this style of publishing, marking things as recent if they’re below the fold but on the home page in full text. This is good for SEO, even though SEO “experts” are trying to steer you away from it.

So, why is this Automattic’s fault?

WordPress comes with a default theme. The last “real” reverse chronological theme out of the box was Twenty Sixteen, though Twenty Thirteen murdered that concept for a year. With that, the “stream of consciousness” reverse chronological blog days were over. WordPress is a trendsetter and its designs often get adopted (and improved upon) by theme authors. A quick glance at WordPress’ most popular themes shows this:

Twenty Sixteen, albeit in there, is the 12th most popular theme but the only real reverse chronological one of the bunch. Twenty Twenty-One is … something else, Hello is a blank theme for Elementor which could, fathomably, be used to make reverse chronological blogs, but this isn’t what Elementor users use the plugin for, but the rest is “Hero first” design. This adds scrolling and/or clicking to see recent posts.

In fact, it’s almost impossible to find a modern, well designed, reverse chronological, theme out of the box.

The solution: get in laterally. Find a place that reverse chronologically shows your friends’ thoughts, ideas, loves, and hates. One that is just in time, a little ephemeral, a little eternal, just like conversations we have.

The place providing this solution: Facebook. Here we still have those reverse chronological listings. But posting on your blog and then linking it on Facebook adds this extra click, so why not just post on Facebook?

Being on Facebook and relying on it as a link provider does have its disadvantages. Facebook doesn’t like to see you go, so unless you’re one of the few approved and Facebook-friendly “blogs” (like Buzzfeed and other crap), your content won’t show up in the feed as much. Facebook decides who gets to see what, not your readers. That’s bad.

And that’s how I met your blogs died.

We love reverse chronology. We love interlinking. And we love things that are written from experience. People who do things and write about them, not people who write to write. We love reading about someone’s day (there is a reason all those family and ego-vlogs are well watched, we identify with the writer or videographer, the subjects in front of the lens or behind the keyboard, and we “adopt” them into our circles.

Blogs gave up this advantage and draw in favour of style over substance, masonry and magazine styles instead of deep connections. Travel bloggers rely on glossy photoshops of HDR enhanced landscapes and posed fake influencer looks in white bathrobes at a deep blue pool, holding a drink. There aren’t very many honest travel blogs anymore.

Blogs tried to compete, gave up their biggest draw, and lost. The strength of citizen writing, personal publishing, stream-of-consciousness was gambled away to compete with something on its own turf. And we lost.


[1] Unless the author chose to have excerpts turned on, but a 2005 internal and unofficial study we did at Technorati showed, that excerpt-on-frontpage blogs seemed to have lower engagement rates)

Ready for another Year(d)

I wish I could claim that this was planned, but an unfortunate trimming accident (pro tip: always check if the #3 distance comb is on the trimmer) leaves me beardless.

Now, lots has been said about my beard, a feature I require because not only does it give me Samson-like powers, it also makes me look less like a douche. Or, to quote one of the residents at work: “You think this leg rotting off a patient is ugly? You haven’t seen Mikka without a beard, yet.”

The good news is: it’ll grow back. And it’s 2020, so we’re all wearing masks in public, anyway. Yay for a potentially lethal viral disease!

Bad news: I indeed am only marginally less shit looking than a rotting leg.

So now my beard has his own category on this blog, reporting frequently on his growth and the return of my powers. And, no, there’s no pointe to this story, just me whining about being too dumb to check the distance setting on my trimmer and having to suffer through the indignities of a shaven cheek once more. I am too old for this bullshit.

Kary Mullis (December 28, 1944 – August 7, 2019)

A surfer dude if there’s ever been one, he was known to leave meetings or come late to work to “catch that ten foot face.”

He identified so much with surfing, he insisted on being shown topless, carrying a surf board, on his autobiography. The publisher talked him into, at least, wearing something over his chest.

He claimed we’d been visited by aliens frequently, believed in UFOs and astrology, and partook in more than his fair share of the Devil’s Lettuce.
And then, one day, he tried to disprove that AIDS was caused by HIV. A scientifically rather problematic theory, but Kary didn’t mind, he went to research ways to prove the presence or absence of specific virii.

And just like that, he invented PCR, the polymerase-chain reaction, a way to use primers to break apart and copy DNA chains.

Today, PCR is the thing you need anywhere in molecular biology. He was awarded a Nobel Prize for it, but spent his acceptance speech complaining about his girlfriend leaving him. Another first for Science.

He was a commensurate swear word machine. Even during his speeches he used all seven of the banned words more than once, not to mention his daily encounters. He was unreliable, experimented with drugs, and once had “an encounter with a psychedelic extraterrestrial raccoon” which, apparently, he consummated a form of marriage with.

That was between his second and third marriage, the unofficial fifth to his official four.

He died, aged 74, a few months before his invention would be in everyone’s thoughts and made the front pages of newspapers. It was from pneumonia after refusing to see a doctor in favor of going back surfing for a week.

Going Postal, Cyprus Style

This is the greatest nightmare (aside from having to go to a public hospital) Cyprus can offer: “package not delivered.”

You arrive at 7:45am because the line already forms for the opening. At 8, of course, nothing opens. SARS-CoV-2 will probably get a medal from Cyprus Post for having made their world and life so much better: the doors are now closed and can only be opened by staff from the inside.

As you wait, past nine and into nine-thirty, you get to watch the staff inside drink Frappé and joke with each other. A few go out back to smoke, some others are on their cell phones.

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Korbinian Brodman (17 November 1868 – 22 August 1918)

For a man who would later neatly classify the areas of the brain, Korbinian Brodman wasn’t one to neatly order his life. He studied Medicine in Munich, Würzburg, Berlin, and Freiburg, left for a while, the returned to pick up his diploma in 1895. Not content, he went back to school and restudied parts of the curriculum in Lausanne before accepting a job back in his first year university’s Hospital, Munich.

Two years later, he went to Leipzig to finish his PhD. That is, if you are counting with me, seven cities in ten years.

He worked for a while in Jena after that, came back to Munich and moved to Frankfurt shortly thereafter. Here he met Alois Alzheimer (yes, that Alzheimer), and the two became fast friends. Alzheimer convinced Brodman to leave Psychiatry, which he considered too mundane, and become a neurologist.

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Duchenne de Boulogne (Sept 17 1806 – Sept 15 1875)

If there is a “father of modern neurology” it would be Duchenne de Bologne, whose work started the field. Though many consider Jean-Marie Charcot its founder, Charcot himself often described de Bologne as his teacher and the true first Neurologist. Talk about bros giving credit.

de Bologne demonstrating muscular contractions on a volunteer, using electric shocks.

Duchenne de Bologne is in my list of unsung heroes because his light is dimmed by Charcot’s and Ramon y Cajal’s, both of which did amazing and important work and are (rightfully) lauded for them.

But there are a few things that remain: his work on muscular dystrophy, while it opened the field to research into so much more, is immortalized in the naming of Duchenne Muscular Dystrophy, Duchenne-Aran spinal muscular atrophy, Duchenne-Erb paralysis, Duchenne’s disease (Tabes dorsalis), and Duchenne’s paralysis. You’ll probably have heard of at least one of those.

But there is more. He also invented the trocar, a surgical instrument to retrieve fluids or small amounts of tissue. He used it to do the first muscle biopsies.

Then he moved on. Believing that nerves had something to do with electricity that was conducted in them as it was in copper wires (not quite accurate, but pretty astounding for this time), he started to use small currents to activate muscles. While doing so, he not only began to map the path of nerves in the body, he also discovered the difference between afferent and efferent nerve strands, and posited that all nerves met near or at the spinal column, but not all took the trek to the brain and back to have reactions to events (this we know for sure is right) but, instead, reacted to signals from the muscle directly via a “shortcut” near or in the spinal column.

He then set out, to analyze facial expressions and emotions. He was the first to talk about microexpressions, about facial reactions so minute you’d have to not blink to see them, and how the brain used them to mimick the person opposite in order to observe itself and see what a specific reaction might say about the person’s mindset. This theory was long forgotten until it was picked back up in the mid 2000s and has now seen multiple verifications in studies.

And, just on the by-and-by, de Bologne revolutionized how medical photography was used.

“de Bologne Slide” of facial expressions. A new use of photography as a teaching tool in medicine.

And the most metal part about this great man? His name. Duchenne got his “de Boulogne” appendix from his colleagues who were concerned that anyone could confuse him with “Duchesne” a big prick of a self-involved physician in Paris with a star attitude. Duchenne embraced the change (he was born and raised in Boulogne) and published under this name until his death two days before his birthday in 1875.

Duchenne’s downfall in fame was his disposition. He is reported to have been a nice person, calm and friendly, until his wife died shortly after the birth of his son. Focussing on work and showing an increasingly erratic attitude, he estranged from his family and his colleagues, antagonizing senior staff he worked for. This period lasted until long after he started his work and might have contributed heavily to the more jovial and collegial Charcot, his student, receiving most of the credit.

His greatest success, however, might be that after his death he still made massive waves in that he influenced Darwin’s theory of facial expressions (which laid the groundwork for Ekman and others) and taught Charcot, who finalized the field of Neurology into a standing discipline. He also taught himself to draw portraits and did so amazingly well from memory, documenting many facial features caused by muscle contractions. The buccinator and sternocleidomastoid muscles were the first he documented, and they torture students with innervation and action to this day.

Åke Senning (14 September 1915 – 21 July 2000)

Senning was born September 14 1915. He didn’t want to become a physician, wanting to be an engineer instead, but it somehow happened. After watching some open heart surgeries, however, he found his passion and trained as a cardiovascular surgeon.

The surgeon he watched, Clarence Crafoord (a hero by himself), would become his mentor in 1948 and, recognising Åke’s talents, Crafoord allowed him to experiment on means to implant pacemakers. In Rune Elmqvist, a former physician who did go on to become an engineer, Senning’s secret passion, he found the perfect partner.

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A forgotten Emergency

Someone walked into my ER this morning (I am a day’s worth of travel south of it) and handed the triage nurse flowers and chocolate for me, to thank me for “caring so much.

“Now, it’s nice to get recognised. But at the same time: I do not do much more than what needs doing, so how bad must this person have felt they have been treated before, to consider my conduct worthy of recognition?

And is it bad that I can not recall the case for the life of me? I a wracking my brain, I have been told the diagnosis, sex, age, and status of the patient, even the day.

And, still, I do not remember them. Not in the least.

I think, honestly, that this is one of the issues we have with health care these days. Patients feel like they are not being taken seriously (every single one of them is, we literally kill ourselves to make them better. We just do a piss poor job, apparently, at showing it), and patients realize that they are but blips on our radar.

People we will (and have to) forget, the second they leave our care.

This was probably one of those cases that fell into a lull in the stream of patients arriving every night (I only did nights for a long time). I probably had the time to explain to them what happened. I probably had time to listen. And I probably had time to show I cared, rather than just caring and carrying on.

This should not be my place. This should be the domain of GPs.

The advocacy role of GP is being eroded by a system that focuses on defensive and rapid medical intervention over lifelong care and support. We’re not healing, we’re fighting fires. This system kills nurses, specialists, and physicians.

In a fantasy world where strong GP/PC physicians are the champions of their patients, there would always be a physician and a bunch of nurses who do not forget. Who will watch over procedures and, very importantly, translate “hospital” to “patient” showing them, that we do care, that we do worry about them and that they do matter.

We can do better. But for this, we have to have a cohesive and coherent medical system in which the patient is not funneled from provider to provider but guided through it by one, strong, advocate.

This starts in policy and politics and does not end with addressing a toxic image of what makes a “good hard” nurse or physician. The patient isn’t the only one suffering from this, and we’d do well to do better, for ourselves and for our patients.