Linda Barlow

I’ve been following the swine flu scare quite closely, having long been interested in infectious diseases that have spread widely, causing the great pandemics of history.  One of the reasons I went back to grad school recently to study biology was because of my concern over the devastation wrought by HIV-AIDS.  I wanted to know more about these deadly agents that can cause so much misery and death.

Influenza subtype A H1N1 is frightening because, according to the CDC, it represents a novel mix of elements from human, bird, and pig influenza virus genomes.  When human immune systems are exposed to a new infectious agent, we have no existing antibodies to attack and neutralize it.  Thus, when confronted with such a pathogen, we’re more likely to get sick than if we had already had full or partial immunity.

Immunology is a highly complex discipline, however, and viruses are tricksy creatures.  From what I’ve been able to understand about the current situation, we’re still in the learning phase when it comes to A H1N1.  We just don’t know enough about it yet.  And even if we did, viruses evolve rapidly.  They lack some of the sophisticated error checkers that do quality control on replication in more complex eukaryotic cells (i.e., the kind of cells we humans are made of).  Thus viruses mutate quickly, which can result in increased or decreased lethality, transmission, and resistance to antiviral medications like Tamiflu.

Flu bugs tend to spread less in the warmer months, which is why our typical flu seasons start in the fall and end in the spring.  In the northern hemisphere, summer is approaching, which should lead to a drop-off of A H1N1 cases (although countries in the southern hemisphere might suffer an increase).  But the World Health Organization and the CDC are concerned that a summer drop-off might be the lull before the storm.  During the post-World War I influenza pandemic of 1918-19, which is believed to have killed 20-40 million people, the flu started in the spring, died down during the summer, then came back roaring the following fall/winter, killing far more efficiently than the usual flu virus.

From what I can make out from reading and digesting a lot of the current information that’s out there, the current H1N1 bug is nowhere near as scary as the 1918 version.  It’s not as lethal, it’s probably less contagious, and it’s apparently not causing death by cytokine storm (where you’re effectively destroyed by your own hyperactive immune reaction).  But viruses being somewhat unpredictable, this could change…which is why we’re being warned to stay alert, cover our mouths when we cough or sneeze, stay home from school/work if we’re sick, and wash our hands frequently with soap and warm/hot water.

This afternoon’s latest alert from the World Health Organization begins like this: “4 May 2009 — As of 18:00 GMT, 4 May 2009, 21 countries have officially reported 1085 cases of influenza A (H1N1) infection. Mexico has reported 590 laboratory confirmed human cases of infection, including 25 deaths. The United States has reported 286 laboratory confirmed human cases, including one death.”

Map of H1N1 cases

Like many women of a certain age (i.e., menopausal), I have experienced the insidious outward creep of my waistline. It’s been awhile since I was last able to fit into my “skinny jeans,” as the girls from Sex and the City named those pants you can’t bear to throw away. But, to my own honest amazement, the day when I can pull ‘em out and slip ‘em on is coming. Since the beginning of August, 2007, I have lost close to 30 pounds, and it hasn’t even been particularly difficult.

I’ve known for some time that I should make the commitment to lose weight, but I haven’t had much success with diets in the past. I used to be a thin person. Unlike many young women, I spent my youth and my 20s blissfully ignorant of the anguish so many other girls experienced as they tried to fit their healthy, naturally rounded figures to the norm of increasing slenderness that has created the anorexic “I wanna look like a starving model” cult of today.

Tall, thin women like my young self didn’t have to diet. Or even (horrors!) exercise. We could eat and eat — pizza, chocolate, ice cream — you name it, and never gain an ounce. We weren’t accustomed to dieting. We didn’t know how.

I did, however, acquire a health foods bug during my 20s, after reading Adelle Davis’s Let’s Eat Right To Get Fit. Unfortunately, Ms. Davis died of the cancer that was supposed to be prevented by her consumption of a healthful diet, so I didn’t stick to her more extreme recommendations. But I never forgot some of her rational, sensible advice: eat a balanced diet with a rich variety of foods, and make sure to optimize nutrition.

In my 30s, after giving birth and living the sedentary life of a writer, remaining thin began to be a struggle rather than a birthright. My naturally skeptical mindset has kept me from drinking the Kool-Aid when this or that bestselling diet fad has swept the nation. I watched my friends try various new diets, lose significant amounts of weight, and gradually regain it. My own attempts to diet, which usually meant eliminating all my favorite foods, were unsuccessful. I could lose 5 pounds, and sometimes even 10, but after a few weeks of depriving myself of foods I enjoyed, I’d go off the diet, make excuses, fortify my willpower, try again, tumble off the wagon once more, get depressed, and a dig into a pint of walnut fudge ice cream to make myself feel better. Or a brownie. Dark chocolate truffles, anyone?

The one time I lost a significant amount of weight was with the aid of one of those extreme diets — you know the type — you drink this liquid protein powder stuff several times a day and don’t eat any solid food. At least, that’s what you’re supposed to do. I’m not good at following the rules, so I insisted to the folks I was paying for this “treatment” that I should be allowed one solid meal a day. To this I added, in violation of the rules, a nice salad of fresh greens. Unlike most of the suckers in this program, I only had about 20 pounds to lose, which actually happened pretty fast (too fast). The poundage gone, I started eating real food again, et voila, you guessed it, I slowly gained back all the weight.

The sad thing about this was that even though I knew I had set myself up for re-gaining the weight (by choosing an eating plan that could not possibly be maintained, and wouldn’t be healthful even if it could be maintained), I still felt like a failure. I had been delighted with the 20 pound loss. I’d bought new clothes! Part of the diet plan had included daily vigorous exercise, which was great, but when the diet ended, I slacked off on that, too. What a loser! I deserved to get fat. Bring on the taco chips.

To make matters worse, a couple of years ago I got a scary result on a stress test. This put me in the hospital for an angiogram. Heart disease runs in my family, and I was still leading a sedentary lifestyle, which is a well-established risk factor. Blood pressure and cholesterol were ok, possibly because, despite the dark chocolate and the chips and salsa, my eating habits were healthier than most folks’. I don’t particularly like red meat, so I rarely eat it. I’ve been drinking non-fat milk and consuming other non-fat dairy products since they started appearing on supermarket shelves. I gave up cheese — even on pizza — many years ago. I avoid processed foods, and anything containing high fructose corn syrup, trans fats, and high sugar or sodium. I love fresh fruits and vegetables and eat them often. I love bread, but only the dark, crunchy, whole wheat and rye berry type. I eat beans many times a week; in fact, legumes and soy products have been my primary protein source for years. Heart disease? Ok, maybe it’s in my genes, but I haven’t helped it along.

Fortunately, the angiogram revealed only a small amount of coronary artery narrowing — about the amount that would be expected, the docs told me, in someone my age. Still, it was a warning. I don’t think anybody is certain how fast this sort of thing worsens.

So…this should have resulted in major lifestyle changes, right? Well, sad to say, it didn’t. Instead I think I went into denial mode, which included continuing to comfort myself with brownies (organic), chips (low sodium), dark chocolate, peanut butter (sugar-free, no salt added), and too much of that delicious whole wheat bread. As for exercise? No way! It was running on that treadmill that had made my heart go all jumpy and put me into the hospital. Forget THAT.

I began wearing increasingly baggy clothes. And I didn’t go out much. What if I ran into somebody I knew? My alter egos — characters in novels and stories — could all be nice and slim, no problem. And I had other alter egos in the form of computer game characters in Guild Wars and LOTRO — not only were they slender, attractive and sexy, but they could run all over Middle-earth without ever breaking a sweat or gasping for breath. Read the rest of this entry »

Every time I start meditating again, I wonder why I ever stopped. Over the years, meditation has proved to be the best strategy I’ve ever found for reducing stress and anxiety. Not only is it very relaxing, but meditation seems to ramp up my creativity as well. I have had some truly visionary experiences while meditating, and, in that quiet inward-looking state I feel much more in tune with myself, with the world around me, and with the essential nature of things.

There is no right or wrong way to meditate. In fact, I’ve long suspected that meditation is a natural state that we practice unconsciously as children, but tend to forget as we grow older. I used to watch my daughter when she was a toddler, and her usual way of relaxing herself was to sit down quietly with her blanket, stick two fingers into her mouth, and suck. She would continue in that dreamy state for 10 or 20 minutes before coming out of it, energized.

But all too often we have to rediscover and teach ourselves the wisdom that we knew as children. I have tried various methods of meditation — all are efficacious. Here’s a simple meditation that always feels wonderful to me. It is both calming and revelatory.

You begin by putting yourself into a relaxed state: sitting still and quiet, breathing slowly from the belly, exhaling for a little longer than you inhale. Let your thoughts drift, and don’t follow any particular line of thought. After a few minutes, when you feel relaxed, you are ready for the four segments of the meditation:

1. Aspire toward the Light.

Inhale slowly, reaching up mentally (or physically stretching up your arms) over your head, toward the source of all light.

2. Receive the Light.

Exhale gently, while lowering your arms and cupping your hands in a receptive state. Feel the light pouring into you.

3. Incorporate the Light.

Inhale with your arms crossed gently over your chest, imagining the light filling your chest and moving up into your head, down throughout your torso and legs, and out through your arms to the very tips of your fingers.

4. Radiate the Light.

Exhale as you spread your arms, palms outwards, envisioning the light flowing through you and out to touch and nurture everyone and everything in the world.

When you have completed the meditative chant, begin again and continue for your usual time period (15-20 minutes is what I usually do), breathing slowly and evenly as you Aspire, Receive, Incorporate, and Radiate the Light.

Depending on your own personal spirituality, you can imbue these meditative actions with whatever imagery best suits you. Here’s what works for me:

1. Aspire toward the Light — Mentally I reach upwards toward the Light/Love that flows through everything. That light is always there, but most of the time I am not consciously aware of it. To Aspire toward the Light (or toward God) is to open myself up and know the Light — see it, feel it, experience it. To aspire is to yearn or desire, and my state of mind is prayerful. Although the Light is always present, I have to direct my attention to it.

2. Receive the Light. This is often quite an ecstatic feeling. Again, it can be argued that we are always receiving the light, but it often feels to me as if I am separated from it, and must re-attune myself to it before I can truly appreciate the splendor and power of divine Light/Love moving through me. I am not, in my ordinary everyday life, a particularly spiritual person, nor do I currently practice any form of organized religion, although I am reasonably knowledgeable about several of the world’s great religions, and have been observant in the past. Meditation puts me back in touch with my spirituality, and makes me aware of certain aspects of reality that do not figure into my day-to-day life. Read the rest of this entry »

The first time I had a panic attack, I didn’t know what was happening, and neither, it seemed, did anybody else. I felt what folks who suffer from anxiety states and panic attacks will well recognize — that foggy, sticky sense of doom. Mind whirring, heart galloping, palms slick and limbs unsteady — surely I was dying, slipping over the muddy edge of my grave; or if not, I was going completely and irredeemably mad.The worst of it was, I was only a little kid at the time. In my innocence, I thought that when I grew up to be wiser and more knowledgeable, I would understand what was happening to me and know there was nothing at all to fear. I would grow up to be strong, brave, and resilient, and I would understand just how silly my childish self had been.

Instead, I grew up to have panic attacks that were even more devastating, since adulthood and knowledge had given me far more things to be afraid of and considerably more medical insight into the various ailments that could be (must be!) stalking my poor trembling body. Combine a certain amount of relevant physiological knowledge with my vivid, complex, natural story-teller imagination, and the playful nip of a neighborhood dog was transformed into a slow, agonizing death from rabies, just as every case of indigestion was either a heart attack or a dissecting aortic aneurysm.

Even though I was rational enough to understand how unlikely these scenarios of doom were, I couldn’t seem to stop the dizzying spiral of mental obsessing, nor the adrenaline surges that played such havoc with my pulse and blood pressure. And then, of course, I further worried (more reasonably) about the very real effect the physical manifestations of my mental terror were having on my heart and blood vessels.

I realize I’m speaking as if this is all in the past, but it isn’t, not entirely. I did learn to understand the neural mechanism of anxiety, and psychotherapy helped give me insight into what may have been some of the factors that increased what is probably my genetic disposition towards some easy-to-excite, slow-to-inhibit neurons. Several drugs, including Zoloft, Paxil, and Celexa among the SSRIs, and Klonopin among the benzos helped during the really bad times (some of the other benzos, like Xanax, had nasty snap-back-into-panic-while-wearing-off effects that discouraged me from using them and my doctors from prescribing them for me). Certain breathing and meditation techniques have also been helpful over the years, as has exercise.

But perhaps the most useful thing I’ve learned about anxiety/panic is that I manage these episodes better when I can just remember to let go and stop fighting. Instead of allowing that almost automatic “Oh no! It’s happening again! What if….what if….what if….” to wind its tentacles into my brain, I get through it much faster and more easily if I can go, “Yeah, yeah, big deal, I’ve seen this all before. If I’m going to faint right here in the elevator and make a scene, then so what, I’ll faint. If I’m about to drop dead, fine, so be it. If I’m about to have a stroke and crash into the tree, then goodbye world. If I’m about to start screaming, hallucinating, and crazily foaming at the mouth, then fine, I’ll be psychotic. Nothing I can do about it, is there? Come on, Fear, I dare ya. Here I am — come and get me.

Usually — not always, but usually — the not-fighting, the acceptance allows the fear to pass over and through me, leaving me shaky, but still standing, still here, still sane, and still able to summon a smile.

This week’s medical news brought a report about the disappointing results of one of the (thought to be) most promising weapons in the small arsenal against HIV-AIDS: a vaginal gel microbiocide, Carroguard. The gel was being tested in a large-scale trial in South Africa and Botswanna. This clinical trial had been ongoing for three years, but unfortunately, the number of women who became infected with HIV during the trial from the group who used Carroguard was very similar to the number of women in the control group who also seroconverted. Essentially, this means the drug did not work.

Granted, there are some questions about the results since it is always difficult to calculate whether the women in the study used the drug regularly and correctly. Did they faithfully insert the gel before having sex? If not, the results of the study may not reveal the entire picture.

Why is this news significant? There are currently about 33 million people infected with HIV-AIDS. Over the years, we have heard of many failures in the various HIV-AIDS agents and therapies, although there have also been some major successes. But the drugs that have been shown to fight the stubborn and infinitely clever HIV virus have not, thus far, prevented infection. Instead, therapies like Zidovudine (AZT) and Nevirapine (which prevent the HIV virus from replicating inside infected human cells) and the HIV protease inhibitors (which stop mature new viruses from being produced) interfere with the HIV virus’s activity after it has already infected its victim. Such agents, usually used in combination with each other, have given life and hope to millions of people infected with the HIV virus. But they do not cure AIDS, nor do they prevent the virus from entering human cells and beginning its deadly siege of the human immune system.

The microbiocide gels work in an entirely different manner. The goal for this type of drug is to prevent the transmission of the virus by blocking its initial entry into human cells. The point here is not to cure the disease, but to prevent a person being infected in the first place.

According to a 2004 report of the Joint UN/World Health Organization, a microbiocide, even if only 60 % effective, could result in a major reduction of new HIV infections among women. If applied vaginally prior to intercourse by 20 percent of women in 73 low income countries, it could prevent 2.5 million new infections over a three year period.

This assumes, of course, that the microbiocide works. Different microbiocides use different methods to achieve their goals – for more on this topic see WHO’s website.

Such an approach is urgently needed. During sexual intercourse, the receptive partner is more susceptible to the virus than the penetrative partner, meaning that women are more likely to acquire the virus from men than vice versa. Since power dynamics in relationships often make it difficult for women to insist upon the use of condoms, the development of a topical agent that women could apply prior to intercourse is vital.

There has generally been a failure by public health officials to recognize that gender inequality all too often deprives women of the right either to decline sex or to insist upon the use of condoms. This situation is worse in some countries than in others, and is related not only to the status of women in a particular nation, but also to their age, level of education, and personal power within their sexual relationships.

If effective microbiocides can be researched and developed, and if women can be taught to use them regularly, they could potentially prevent millions of new infections in the years to come. This would greatly benefit women at risk for AIDS, an important goal since women now represent 50 percent of the global total of AIDS-infected individuals. It would also benefit children, since it is believed that 97 percent of infants with AIDS acquire the virus from their mothers.

More info on microbiocides

Paper written by Linda Barlow on macrobiocides