1. Trying new positions in the vain hope that I will finally find one that feels good to all parts of my body simultaneously.  I have these stupid arms that always get in the way.

2. Worrying about stuff.

3. Thinking about enjoyable things to get me off the worrying topics, which keep me up.

4. Thinking about relaxing things to get me off the enjoyable topics, which also keep me up.

5. Giving the internet another chance, after a serious let down earlier tonight.  The one thing the internet promises is endless diversion so I get really indignant when I run out of stuff to do online.  Maybe I should take up video games?

6. Feeling guilty about wasting time online and switching over to writing a cover letter.  This completely undoes any progress on relaxing and being happy and lands me squarely back at worrying, because I do not have a job and I need one, and now I’m really fucked, so I might as well just get up and have breakfast.

Which in this case is half a cherry danish.

This has put me in the mind of other failings that this mortal shell of mine commits.  I am not the shrimpiest person you’ll ever meet but I am on the short side and this has always been something of a personal tragedy.  I have always admired tall women and when they start offering leg implants I will be first in line.  Just think of the advantages: for starters I’d be able to reach the high shelves in the kitchen, which in my case includes the liquor cabinet.  Also how awesome would I look if I were closer to six feet tall as opposed to my current proximity to five?  Answer: super awesome!

I would also like to have skin that could self regulate rather than my own epidermis which requires constant maintenance with moisturizer otherwise I turn into a lizard/raisin hybrid and become indistinguishable from a dessicated mummy.  Which is to say dry.  I like moisturizing as much as the next person but there are days when I would prefer to skip it but I dare not lest someone set me afire in an attempt to get my evil curse to end.

Also, this is really trivial, but I do wish I had nice long fingers.  I got my dad’s hands and though they have great utility for most tasks they will never make it as concert pianists.  They are boxy and a little on the stumpy side which causes me to do a lot of wistful sighing when I see women with long fingers.

Finally, I could complain about my eyes here but really, I have been wearing glasses since the fourth grade and I just don’t think of my vision as an issue.  Especially once I bought the super light frameless glasses, dealing with my short sightedness is almost effortless and the only time I have to think about it is when I come in from the cold and the lenses fog over and blind me.  Or when they get rained on, that’s a hassle.  But you know, I wear my glasses for more hours of the day than my underpants so they just seem like part of me.  And frankly glasses are less of a hassle than underpants because glasses never give you a wedgie.

This automated email message is being sent to all physicians in BC by the College of Physicians and Surgeons of British Columbia on behalf of the BC Ministry of Health Services, the BC Centre for Disease Control, the College of Physicians and Surgeons, and the British Columbia Medical Association. Please do NOT reply to this email address.

September 28, 2009

RE: Pandemic (H1N1) Influenza Issues Update

At the request of B.C.’s physicians, a web resource has been established to provide a centralised and ongoing source of current information about the emerging issues surrounding the novel 2009 pandemic H1N1 (pH1N1) influenza virus (see http://www.hls.gov.bc.ca/pho/physh1n1.html - please bookmark this site). You are encouraged to visit the website and sign up to receive notifications when significant updates or additions are available.

In B.C. we work closely with many partners to provide accurate and timely information for providers and the public. The Office of the Provincial Health Officer has developed an ongoing process, including the establishment of formalized working groups, for expert review of the materials that will be posted to this site.

Throughout the evolving influenza season we will update and revise this information as necessary and also provide access to provincial- and health-authority specific information.

In particular, we draw your attention to the following points below. Please see the website for more details and regular updates.

SEASONAL INFLUENZA VACCINATION

As a result of national level discussions about the complexities of concurrently running 2 or even 3 influenza vaccine programs, the possibility of novel 2009 pandemic H1N1 (pH1N1) influenza infections replacing the usual predominance of H3N2 infections, and the potential interaction between seasonal vaccine receipt and pH1N1, we have made the following decisions:

Vaccination against seasonal influenza using the trivalent product (contains the three strains of influenza virus – A/Brisbane/59/2007(H1N1), A/Brisbane/10/2007(H3N2), and B/Brisbane/60/2008) will:

• Be targeted in October for those aged 65 years and older and residents of long term care facilities beginning mid-October;
• For others at higher risk of influenza complications the seasonal vaccine will be offered following the November-December delivery and administration of the pH1N1 vaccine (i.e. seasonal trivalent influenza vaccine will be offered to eligible persons in early 2010). More details on this latter offering will be forthcoming.

In addition, we recommend that workplace-based seasonal influenza immunization programs be delayed until after the pH1N1 vaccination programs have been implemented (i.e. pH1N1 vaccination programs are expected to be completed by end of 2009).

Note these are subject to change if the regular seasonal H3N2 virus makes an unexpected recurrence.

Given patterns of activity over recent years in the northern hemisphere, and more recently in the southern hemisphere this past season, it is considered unlikely that seasonal influenza H3N2 strains will play a major role in influenza illness early in the 2009/2010 season. Thus, delay represents the best balance of benefits, risks and logistics while the focus is on preventing pH1N1 illness.

B.C. has thus made a decision to delay the usual broader offering of seasonal influenza vaccination. We are also aware of preliminary research findings suggesting that prior receipt of seasonal vaccine was associated with moderately increased likelihood of pH1N1 illness (odds ratio approximately 2) during the spring/summer 2009 in Canada. Although this association has not been linked to more severe disease or found in other countries and study methods are still undergoing scientific peer review, expert opinion has been to take the results into consideration pending more definitive knowledge and this has also informed decisions. Should patients under the age of 65 request seasonal influenza vaccine prior to receipt of pH1N1 vaccine, they should also be informed of this so they can make an informed decision.

TESTING FOR pH1N1 FLU VIRUS

Most adults and children with pH1N1 will have typical influenza-like illness. Nearly all children are infected with a number of different viruses during winter and pH1N1 is another with similar signs and symptoms. It is at the clinical discretion of the physician whether the patient needs testing for pH1N1 and/or treatment with antivirals.

Test ONLY to support appropriate treatment as follows:

• Patients NOT at high risk for complications, with typical influenza-like illness who request testing, should be advised that it is NOT NECESSARY.
• Testing by nasopharyngeal swab is recommended only for cases of influenza requiring hospitalization or if the test result will affect management (such as discontinuing antivirals based on a negative test in a pregnant woman).
• As antiviral medications are most effective when started early, treatment decisions in the community should not wait for the results of laboratory testing if performed, but should be made based on the severity of symptoms, the presence of risk factors and the influenza viruses circulating in your community.

ANTIVIRAL TREATMENT FOR pH1N1 FLU VIRUS

If influenza is strongly suspected based on clinical presentation and the presence of pH1N1 is in the community, antiviral use should be considered for the following patients:

· All patients (including children) with moderate to severe clinical influenza-like illness regardless of whether they are admitted to hospital;

· Patients with milder illness who may be at higher risk for subsequent complications, including:

o Pregnant women

o Adults and children with chronic health conditions including cardiac or pulmonary disorders (including bronchopulmonary dysplasia, COPD, cystic fibrosis and asthma), diabetes mellitus, other metabolic diseases,  cancer, immunodeficiency or immunosuppression, renal disease, anemia or hemoglobinopathies as well as conditions that compromise the management of respiratory secretions and are associated with an increased risk of aspiration

You may wish to consider giving higher risk patients a prescription in advance, seeing patients quickly if they develop influenza-like symptoms and planning for calling in a prescription if the person becomes ill. To help guard against the development of resistance, please familiarize yourself with the proper antiviral dosing regimen and duration and reinforce clinically-indicated use with patients. Currently, dosing regimens are unchanged from that of regular seasonal influenza, and are dependent upon weight and require adjustments for people with renal failure. Check package inserts. The WHO also advises that risk of antiviral resistance is higher in severely immuno-compromised people with prolonged illness and persistent viral replication given extended treatment and in patients given post-exposure prophylaxis.

REPORTING CASES OF pH1N1 FLU VIRUS INFECTION

Physician reporting of serious outcomes dues to pH1N1 influenza is important to monitor the impact of the pandemic. Physicians are required to report to their Medical Health Officers any cases of lab-confirmed pH1N1 respiratory infection:

• Whose illnesses are severe enough to require admission to hospital; or
• Who die, regardless of whether admitted to hospital.

pH1N1 INFLUENZA VACCINATION

pH1N1 vaccine is anticipated to be available in both adjuvanted and non-adjuvanted formulations by mid-November with the possibility of earlier emergency release. Non-adjuvanted vaccine will be available for pregnant women and children under three years of age and has been selected because there will not have been adequate testing of adjuvanted product on these groups.

Enough vaccine is anticipated to be available to immunize all British Columbians and those visiting B.C. who need and want to be vaccinated.

The immediate priority will be to target those who are anticipated to need and benefit most from immunization, as well as those who care for them, including:

· persons with chronic medical conditions under the age of 65

· pregnant women

· children 6 months to less than 5 years of age

· persons residing in remote and isolated settings or communities

· health care workers involved in pandemic response or who deliver essential health services

· household contacts and care providers of infants < 6 months of age and persons who are immunocompromised

· populations otherwise identified as high risk

Early indications are that a single dose might be adequate for older children and adults.  Younger children (age to be determined) may need two doses given three weeks apart.

Vaccine will be available through health authorities, special clinics organized by public health nurses, physicians’ offices, community health nurses who work in First Nations communities, and through health care facilities for health care workers and residents of long-term care. Details of clinic dates and locations will be available through the regional health authorities or local health unit.

We commit to keeping the medical community updated on any further changes.

Sincerely,

P.R.W. Kendall Eric R. Young, MD
OBC, MBBS, MHSc, FRCPC BSc, MHSc, CCFP, FRCPC
Provincial Health Officer       Deputy Provincial Health Officer

Message from the College of Physicians and Surgeons of British Columbia

The College of Physicians and Surgeons of British Columbia appreciates the work of provincial experts and the collaboration of many stakeholders in compiling a single provincial source of reliable information regarding the diagnosis and management of novel pH1N1 influenza. Successful management of pandemic influenza is dependent upon timely dissemination of relevant information to those who need to know. We strongly encourage your participation in subscribing to the updated features of this website to ensure that the physicians who manage influenza-like illness (ILI) are conversant with the management and treatments listed.

Dr. Heidi Oetter, Registrar

Dr. W. Robbert Vroom, Deputy Registrar , CPSBC liaison to pH1N1 Clinical Advisory Committee

Message from the BCMA

The BCMA is pleased that there will be one source of reliable information for physicians about H1N1. We believe this approach will greatly reduce possible confusion about emerging information and minimize the time physicians and their MOAs will need to spend on keeping up-to-date about the issue. The BCMA has agreed to assist in sending notices of important updates to members.

Brian Brodie, MD
President, BC Medical Association

I am a creature of habit, more so than most people I think.  When I hit on something I like I will stick with it for a long time.  For example if I really love a song I can listen to it over and over for hours at a time.  Or several hours at a time, every day for weeks in a row.  I have been ordering the same sandwich at Subway two to four times a week for the last three years.  I have certain books that I have been reading once or twice a year for over a decade.  I only use one brand of toothpaste, the brand I’ve been using since childhood.

What I am saying is I like predictability and on the personality scale “openness to new experience” I score low.  Travel is new experiences – travel upsets me greatly.  Even though I am staying with a great friend and even though I am on a fantastic course, I really just wish I was home.

Strangely, I used to live here (I am on the east coast), but that doesn’t seem to be helping.  In fact every time I see some familiar sight from my time here, I get a wave of loneliness that I just can’t explain.  So I am finding it very painful to be here.

Still, despite it all, I am glad I came.  I have had other experiences this week that have changed me for the better I think, and so it is not all gloom and doom.

Just some of it.  Particularly at this moment.

I am not sure what I’ll do with this space in upcoming days.  For now I will leave you with this, a very favourite song of mine, an old (and sad) QOTSA track.

It starts with an entirely gratuitous scene of what can only be described as soft, soft core porn as the lead actress (someone or other) strips down to her panties, helpfully bends over to turn on the shower with her bottom pointed at the camera, and then treats us to an extended but steamed over view of her body naked under the faucet.

Then the movie starts.

I guessed the bad guy within a minute of his appearance on screen – both of them.  The main cop figure has (of course) a chip on her shoulder which causes her to freak out if she thinks anyone is questioning her ability.  The fights in the snow are hard to follow.  The ending is so anticlimactic you probably shouldn’t even call it a climax.  And, strangest of all, despite a crazed axe murderer being loose in the tiny, claustrophobic setting of a research station on Antarctica, all the staff except the protagonist and maybe two other people are in major party mode because they are about to cut it really close to an incoming storm that might stop them from evacuating the continent before winter sets in.  Um… okay.

And how could one possibly forget, of all others, this technique in the art of living?  It is conspicuous for a most remarkable combination of characteristic features…. But it does not turn away from the external world [as other ways to attain happiness do]; on the contrary, it clings to the objects belonging to that world and obtains happiness from an emotional relationship to them.  Nor is it content to aim at an avoidance of unpleasure – a goal, as we might call it, of weary resignation; it passes this by without heed and holds fast to the original, passionate striving for a positive fulfillment of happiness.  And perhaps it does in fact come nearer to this goal than any other method.  I am, of  course, speaking of the way of life which makes love the centre of everything, which looks for all satisfaction in loving and being loved.  A psychical attitude of this sort comes naturally enough to all of us; one of the forms in which love manifests itself – sexual love – has given us our most intense experience of an overwhelming sensation of pleasure and has thus furnished us with a pattern for our search for happiness.  What is more natural than that we should persist in looking for happiness along the path on which we first encountered it?  The weak side of this technique of living is easy to see; otherwise no human would have thought of abandoning this path to happiness for any other.  It is that we are never so defenceless against suffering as when we love, never so helplessly unhappy as when we have lost our loved object or its love.

From Civilization and Its Discontents, 1927.

Bad news: my internal female parts have gone back into revolt, which I assume is some kind of aftershock phenomenon from the IUD.  It’s been a week of feeling sometimes fine alternating with sometimes crampy after the total hell of insertion day, but right now I am back in full on pain.  All I want to do is lie in bed and, since sleep seems a remote possibility, allow my mind to wander.  Maybe watch some bad TV, maybe have a rye.  I would probably offer up my prized collection of Philip K. Dick books for a slow back rub.  But back in real land world, I will be hosting, cleaning, making dinner for guests, and doing girly nailpolish stuff with my neices.  Those are all good things, I just find it hard to enjoy them when I feel like I’m being stabbed in the guts.

So I am feeling rather sorry for myself right now.  Sulking is unbecoming but if you can’t be self absorbed on your own blog, then really, where can you?

So I am about to head back to the alteration store to kick up a fuss.  It has to be done today so I can pick it up tomorrow because that is my last opportunity before the wedding.  Did I mention they were supposed to call me when the dress was altered but never did, which is why I am discovering this mess at the final hour?

This is why being in a wedding party sucks.  Back ass, squashed tits, frantic last minute arm waving at hapless sales clerks.  I hereby thumb my nose at all weddings.

PS – If I weren’t doing this stupid shit, I could be at the aquarium with my nieces, which would be so fun!  I love the aquarium but find it hard to persuade other adults to go with me.  Enter a ten and a twelve year old and you magically have social sanction to go coo at fishies.  Except there is no cooing for me, dratted dress!