Monday, July 25, 2016

Fatigue – what could rheumatology patients learn from pilots?



I’ve seen a study on pilots complaining about fatigue. Fatigue, however, is a daily problem in rheumatology. No matter if patients suffer from rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or fibromyalgia, fatigue is always a hot topic. Fatigue on its’ own may promote other health problems and effect work-life balance.


Pilots face irregular working schedules – patients face irregular disease activity.
Pilots may have long working hours and/or cross time zones – patients might suffer from longer hours of pain and missed sleep.
Pilots and patients may suffer from sleep disturbances and fatigue due to desynchronized biorhythm (daylight, when there should be darkness, high cortisol, when it should be low).



What can be extracted for patients’ benefits?


• expose yourself to daylight; avoid staying in the dark during daytime, when you feel depressed because of pain

• ask your rheumy to adjust your steroids (avoid second dosage or even evening dose of prednisone)

• work on sleep behaviour, develop a sleep ritual, and look for regularity (same time every evening) as well as timing of sleep (allow enough time)

• planned nutrition might help (no large meal before bedtime, a small amount of complex carbohydrates may help however)

• time your physical activity well before sleep time, but exercise regularly

Reference:

Alwin van Drongelen and colleagues: “Development and evaluation of an intervention aiming to reduce fatigue in airline pilots: design of a randomised controlled trial”.
BMC Public Health
2013, 13:776 doi:10.1186/1471-2458-13-776

Friday, July 22, 2016

FreitagsGedichte / Kurze Gedichte



GüterZüge
    endLose
GüterZüge
Rollen
Und
Rollen
Bis
Auf die
Die
Auf den
    AbStellGleisen
Warten


Axt
    die Axt
Die
Den Baum
Fällt
Schmerzt
Nur
Der Stiel
Denn
Er ist
    Das Kind
Des Baumes

Rakete
    wie eine
Rakete
Die
Große Saturn V
Startet
Das
Leben
Erst
BeWegt es
Sich
Kaum
Dann
Wird es
    Immer
Schneller

Im Alter
    dieses
Kratzen
Im Hals
Das
Brechen
Der Stimme
Ist
NochMals
    StimmBruch
AnGesagt?

Barmherzigkeit
    über
Kirche
FriedHof
Das offene
Grab
Schlichen
Die Wolken
HinWeg
LautLos
Und
    Regneten ab
Im Bergischen

Möven
    folgen die
Möven
Den
Schiffen
Oder
Haben sie
Ganz
Etwas
    Anderes
Im Sinn

Fünf Tibeter
    wären
Die
Fünf
Tibeter
Auch
ErfolgReich
Als
Fünf Iraker
Fünf Spanier
    Oder als
Fünf Tonganer?

Zählung
    es ging
Aber
Das Gebot
Aus
Sich schätzen
Zu lassen
Und
EinJeder
Ging
    Zu seiner
KFZ-ZulassungsStelle

BuchHeim
    da stehen
Jetzt
Häuser
Wo
Früher
Kirmes war
Für kurze Zeit
Und
Sonst
Pützen
    Nein, tiefe
Nasse Löcher

Zigarette
    die E-Zigarette
Ist
Keine
Zigarette
Denn
Sie kann
Nicht
Die letzte
    In der
Schachtel sein



Friday, February 19, 2016

Twitter and more

I've just encountered problems to access the internet, especially my own blog and Twitter. I haven't found a solution, yet, but I'm working on it, which means I call the guys from IT. I had my coffee 1.0, but obviously this didn't help.

PS. Just tried to send this message to Twitter. Impossible.

PPS. I've just received an email by our IT manager: "...
aufgrund der aktuellen Sicherheitsprobleme bedingt durch die Cyberangriffe auf Krankenhäuser, wurden zahlreiche Schutzmassnahmen ergriffen.Unter anderem ist jeglicher Download aus dem Internet (somit auch der Dateizugriff), WebMail und div. Seiten gesperrt. ...". He refers to cyber attacs on hospitals in Germany, one of them is located only 10 km from here; German link: http://www.rundschau-online.de/newsticker/cyber-attacke-auf-klinik--ermittlungen-wegen-versuchter-erpressung,15184906,33815836.html. So nearly everything is blocked now.

22.07.2016
I've just got access to my blog again! Hooray!
New entries will follow soon.

 
Test-Picture 
 

Thursday, February 18, 2016

Carpe Diem Haiku Theme Week No. 1 episode 4: The Tibetan Book of Living and Dying: Insight 3 "thinking about death gives life meaning"


 

Frozen rivulet
During spring there comes the sun
Stream dances again

The sky has opened
Above the burning ghat
Smoke rises with souls

(too bad, the picture to the second haiku is with the Tibet pictures)



Carpe Diem Haiku No. 920 Hunger (Empathy)


Man at waste basket
Shopping cart with PET bottles
Give him your refunds

A boy and a girl
Sharing a banana peel
Hunger always hopes



Carpe Diem Haiku Tokubetsudesu No. 70 Tibetan’s Mgur, a religious form of poetry


Winter time of frost
Hot butter tea is ready
Meditation gone

Cut off all desires
But still there's the smell of soup
Throuout the temple

Flying prayer flags
The wind is our messenger
Gompa* and vastness

* Gompa means small temple


A couple of years ago I had the opportunity to visit Milarepa's cave. Pelgye Ling Monastery is built around this cave. The air at an altitude of at 3,750 metres (12,300 ft) is clear, smelling of wild flowers and herbs from the valley of Lapchi Gang. Pilgrims come with offerings. Often small bank notes are left behind. Monastery is affiliated with the Gelugpa Sera Monastery in Lhasa. For more details look at Wikipedia under Milarepa's cave (that's where my information comes from).

















 The valley of Lapchi Gang


Pelgye Ling Monastery


Inside the cave


Inside the cave

.



Wednesday, February 17, 2016

WIN Olokizumab


I’ve just noticed that people have been interested in my article from 2013 “Olokizumab – any new developments?” I therefore adopted the WIN (=what is new?) from the ACR meeting sessions.

To tell the story in short, let me begin a little bit earlier than at “what is new?”. As nothing on olokizumab appeared at the EULAR meeting in Madrid in June 2013, I wondered: “Nothing! / Very strange as olokizumab targets interleukin-6 (IL-6). … Postponed or abandoned?” In July 2013 there had been an announcement by UCB: “UCB out-licenses RA drug olokizumab to Russia's R-Pharm”.
In 2014 I thought that olokizumab had been abandoned as nothing had been published at the EULAR 2014 Meeting in Paris.

MC Genovese and colleagues published: “Efficacy and safety of olokizumab in patients with rheumatoid arthritis with an inadequate response to TNF inhibitor therapy: outcomes of a randomised Phase IIb study” in Annals of the Rheumatic Diseases (2014).
MC Genovese and colleagues (other group of researchers) published at the ACR 2015 Meeting in San Francisco: “Long-Term Safety and Efficacy of Olokizumab in Patients with Moderate-to-Severe Rheumatoid Arthritis Who Have Previously Failed Anti-TNF Treatment“. The researchers looked at data from Western and Asian patients. Conclusion: “OKZ [OLOKIZUMAB] was well-tolerated, with an expected safety profile for this class of agent. Reductions in disease activity were sustained to Wk48. These results support the development of OKZ for the treatment of moderate-to-severe RA in Western and Asian pts.”

These recent studies aren’t so interesting in the results, but still there is a story being told. UCB still hasn’t given up and keeps a low fire burning. I doubt that olokizumab will be approved as a drug against rheumatoid arthritis.


References:
Olokizumab – any new developments?

UCB out-licenses RA drug olokizumab to Russia's R-Pharm

Newer Biologics at the EULAR 2014 Meeting in Paris

Genovese MC, Fleischmann R, Furst D , Janssen N , Carter J, Dasgupta B , Bryson J , Duncan B, Zhu W, Pitzalis C, Durez P, Kretsos K. Efficacy and safety of olokizumab in patients with rheumatoid arthritis with an inadequate response to TNF inhibitor therapy: outcomes of a randomised Phase IIb study. Ann Rheum Dis. 2014 Sep;73(9):1607-15. doi: 10.1136/annrheumdis-2013-204760. Epub 2014 Mar 18. http://www.ncbi.nlm.nih.gov/pubmed/24641941

Genovese MC, Fleischmann R, Tanaka Y, Furst DE, Yamanaka H, Joshi R, Zhu W, Shao J, Mashimo H, Takeuchi T. Long-Term Safety and Efficacy of Olokizumab in Patients with Moderate-to-Severe Rheumatoid Arthritis Who Have Previously Failed Anti-TNF Treatment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/long-term-safety-and-efficacy-of-olokizumab-in-patients-with-moderate-to-severe-rheumatoid-arthritis-who-have-previously-failed-anti-tnf-treatment/. Accessed February 17, 2016.

.