Der ultimative Weihnachtsbaum

Gestern habe ich ihn endlich gesehen, den ultimativen Weihnachtsbaum. Wie kein anderer unter der Schar von kleinen bis großen Tannenbäumen, die noch auf ihren Schmuck warten, ist er zum Spiegelbild unserer Gesellschaft auf gestiegen.

Hier ist er nun:

Und hier ist seine Spitze:

Ist es eine Spitze? Nein, dieser Baum wartet gleich mit vier Spitzen auf. So läuft es auch in der Politik. Wir machen als Wähler direkt mehrere Parteien stark. Keine ist ganz spitze, aber alle fühlen sich als Spitze. Und dann zerfließen die letzten Kräfte in den Ausschüssen.

     Lehre 1 vom Tannenbaum: triff klare Entscheidungen.

Der Baum ist über und über behängt mit Geschenken. So wünscht es sich der Einzelhandel. Mehr und mehr fördert Stress und Stress macht krank. Warum tun wir uns dieses Fest an? Wo ist die Beschaulichkeit? Und dann erinnert man sich an die früheren Weihnachtsfeste, zu denen die Welt noch in Ordnung war. Wirklich? Gab es nicht diese ... Kriege? Katastrophen? Aber das Elend kann man ja zu Weihnachten ausblenden.

     Lehre 2 vom Tannenbaum: früher war es anders, nicht besser.

Nach dem Kaufrausch können wird uns in die Behaglichkeit zurückziehen. Die Schräglage des Weihnachtsbaumes zeigt an, wie sehr wir unser Konto überzogen haben. Wie sehr wir uns vom Kapitalismus haben überrumpeln lassen. Dieser Geschenkwahn verbessert nicht nachhaltig die Wirtschaft. In der Wegwerfmentalität verschaffen wir der Wirtschaft nur ein kurzes Röcheln.

     Lehre 3 vom Tannenbaum (und das ist eine alte Lehre): weniger ist mehr.

Gleich scheint er umzukippen. Gleich scheint er auf die fallen zu wollen, die den Kirchgang nur zu Weihnachten vorsehen. Warum denn jetzt in die Kirche gehen? Jetzt ist es Stress, sonst ist genügend Platz vorhanden. Aber davon möchte ich nun den Gelegenheitschristen nicht abraten. Geht ruhig zum Gottesdienst, zur Messe. Vielleicht kommt Ihr ja wieder. In Notzeiten ist man eher bereit, Werte zu bewahren als materielle Werte ersatzweise unter den Weihnachtsbaum zu legen. Und auch da zeigt sich wieder unser Weihnachtsbaum, denn seine Geschenkpakete sind leer.

     Lehre 4 vom Tannenbaum (ein wenig triefender Kitsch lässt sich nun nicht mehr vermeiden): Schenkt Euch weniger materielle Dinge, sondern schenkt Euch Liebe!

Frohe Weihnachten!

New Zealand Itinerary with Annotations and Pictures

My last travels have let me to the South Island of New Zealand during November and December 2013. Here’s my itinerary with annotations and already some picture. Details on observations will follow soon.

DUS – DXB

Nightflight.

DXB – BKK

Some sights right after the start. India under a veil of clouds. Some sleep.

BKK – SYD

A beautiful morning across Australia.

SYD – CHK

Nice views of Aotearoa. Especially I liked seeing Mt. Cook / Aoraki and the West Coast; I could see exactly, where I was going to be on the second half of the trip.

The mountains merge with the clouds, also to be seen Okarito

CHK – Hillmorton – Halswell – Little River – Takamatua - Akaroa – Flea Bay

No hassles at the airport. I feared having to drive into the evening, but light stayed until past 9 p.m. Akaroa is reached by a steep road. It retains some French flair and some streets still have French names, but I guess the real reason behind this is tourism. Just went to the supermarket as I was heading for the wilderness.

Flea Bay

Flea Bay or the Pohatu Marine Reserve isn’t far away from Akaroa, but you need to travel by gravel road, which is very steep and dangerous. The bay is a dream. You hardly see other people, sometimes a couple of hikers. The house was small, basic, and the toilet (no WC!) 30 m away from the house. Only natural sounds around: wind, waves, penguins, sheep, cattle. Very relaxing. Liked the small blue penguins very much.

Broom in bloom

Flea Bay early in the morning

A little blue penguin

On the way to Akaroa

Flea Bay – Akaroa – Tai Tapu – Lincoln – Burnham – Rakaia – Ashburton Geraldine – Fairlie – Burke’s Pass – Lake Tekapo

Lake Tekapo

I stayed with my friends at the ritzy Opera House (named after the Sydney Opera House). The Church of the Good Shepherd and the Shepherd Dog Memorial as well as Lake Tekapo were well in sight of the house and its huge balcony.

Some trips around Lake Tekapo, to Lake Pukaki, and to Mt. John and its observatory.

The Church of the Good Shepherd at Lake Tekapo

Lake Tekapo – Twizel – Omarama – Clearburn – Lindis Pass – Lindis Valley – Tarras – Lake Dunstan – Cromwell – Kawaru Gorge – Gibbston – Frankton – Queenstown

Nice Café in Tarras.

Bungee jumping at Kawaru Bridge.

How close are jump and dumb?

Queenstown

We only stayed overnight in Queenstown (outskirts).

Queenstown – Kingston – Fairlight – Garston – Nokomai – Athol – Parewa – Five Rivers – Mossburn – The Key – Manapouri

Red Tussock on the way

Manapouri

Large house, good view of Lake Manapouri.

The trip to Milford Sound was extraordinary. Very good weather. Only the mirror lakes weren’t mirroring the surroundings. Kea were up to their reputation, trying to take the car apart. Mitre Peak in broad sunlight with a nice reflection on the water. Seals and one (1) penguin.

Kepler Track (only first part). Rainforest in sunlight and also during a light rain.

Borland Road with some nice views, but the power lines were always in sight (Green Lake / Grebe River). Monowai Lake is more for people with boats.

Te Anau and the Takahe.

Kepler Track

Mitre Peak

Seals on their preferred rock for a sunbath

Kea

Takahe - there are only 300 left!

Manapouri – The Key – Mossburn – Lumsden – Balfour – Riversdale – Mandeville – McNab – Pukerau – Waipahi – Clinton – Toiro – Otamomo – Port Molyneux – Kaka Point – Nugget Point

Nugget Point

Penguins and quite a lot of them at Roaring Bay!

We looked closer at the Catlins.

Also seals / sea lions.

Staying in a house on a rock. Also a wonderful garden.

Penguins at Roaring Bay into the bay

Penguins at Roaring Bay coming out of the water

Penguins at Roaring Bay going back to the sea

Rocks with nesting birds - Nugget Point

Nugget Point - Lighthouse

Nugget Point – Kaka Point – Balclutha – Crichton – Manuka Creek – Waitahuna – Lawrence – Beaumont – Miller’s Flat – Ettrick – Roxburgh – Coal Creek Flat – Alexandra – Clyde (please, don’t let the dam break!) – Cromwell – Lowburb – Mt. Pisa – Queensgate – Luggate – Albert Town – Lake Hawea

On the way to Lake Hawea

Lake Hawea

Splendid view! The house has the best view and the name Bellevue has been righly given.

Wanaka – Glendhu Bay – Matukituki Vallley / Mt. Aspiring -: this tour brought me very close to some bulls and of course to a walk near Mt. Aspiring.

Lake Hawea - from the house

Black bull

Mt. Aspiring

Lake Hawea – Makaroa – Haast Pass – Haast Junction – Knight’s Point – Moeraki – Lake Paringa – Bruce Bay – Jacob’s River – Karangarua – Fox Glacier – Franz Josef Glacier – Tatare – The Forks – Okarito

Fox Glacier - what global warming has left

Okarito

Wonderful mirror effects in the lagoon. I saw a white heron, but couldn’t make a photograph because I had been driving.

First glimpses of the West Coast

The beach

Southern Alps across Okarito Lagoon

After sunset - the better part belongs to the lagoon

Okarito – Whataroa – Harihari – Kakapotahi – Ross – Ruatapu – Mananui – Takatai – Hokitika – Seaview – Kaikinu – Mumara Junction – Kumara – Dillmanstown – Jacksons – Aickens – Otira – Arthur’s Pass – Bealey Spur

Arthur’s Pass / Bealey Spur

Bridal Veil Falls. Devils Punchbowl.

Lupines - not the "Dimly burns the light of the lupines" variety of Ingeborg Bachmann

Devil's Punchbowl

Kea

Bealey Spur – Cass – Castle Hill Village – Porters Pass – Springfield – Sheffield – Weddington – Darfield – Kirwee – West Melton – Yaldhurst – CHK

CHK – SYD

Soon in the clouds. Sunny Sydney.

SYD – BKK

Started right into the evening.

BKK – DXB

Reached Dubai at dawn.

DXB – DUS

Nice views of the emirates. Then clear view above Iran with Isfahan, Zagros Mountains and Mt. Ararat. Some Nice views of Poland, too.

Other texts on this New Zealand travel:

New Zealand Haiku First Series: http://rheumatologe.blogspot.de/2014/01/new-zealand-haiku-first-series.html

New Zealand Haiku Second Series http://rheumatologe.blogspot.de/2014/01/new-zealand-haiku-second-series.html

Carpe Diem's Sweet Memories

After the muezzin´s call

The rooster crows

Until the morning brightens

After a very hot day in Borobudur (Indonesia) I could not find sleep, then slept, but have been awakened into a very nice morning. The breeze has been fragrant. The night had cooled down the temperature. And then the rooster crowed. As the morning was getting brighter, the bats returned to under the roof tiles; they were quick and precise. I wondered how they’d fit in the small space, but they did. The cat was always trying to reach them but didn’t succeed. So this morning entered my notebook od sweet memories.

http://chevrefeuillescarpediem.blogspot.de/

Functionalism or Structuralism in Rheumatology?

What is needed more in rheumatology? An approach from the functionalism viewpoint or from the one of structuralism?

When I studied social anthropology I have been interested in the question of whether functionalism or structuralism would serve the scientific purpose more. Let’s apply a few thoughts of this field to rheumatology.

Of course, we need an approach from structuralism as we deal often in changes of joints and bones. On the other hand, what do we get out of this angle in terms of social functioning? I think that rheumatic diseases are far more than a definition in terms of structuralism. Pain and inflammation have an impact on body and mind. And this impact also works on social functioning and social role, in family, community, and/or work. Pain and inflammation are better looked at from the functionalism point of view. You can see structural damages on X-ray charts or MRIs for instance, but these charts don’t tell you anything about the impact on how the patient in interacting with the physical and social environment. Yet, on a visit at the rheumatologist looking at X-ray charts and talking about possible damages take a lot of time. Also we tend to talk more about lab results than on issues concerning social functioning.

So this short note is striking a blow for an approach from the functionalism angle of view! Let’s use structuralism more for background information, but talk more about the impact on the disease on functioning. In this way I hope that we can restore normality to people, who have been overrun out of a sudden by a disease that will stay and work against them. Let’s talk more about what is possible in term of social functioning and what still needs attention.

Carpe Diem Haiku Land of the Free

Light flooding the Shire

Ho! The skylark flies and sings

Orcs keep to Mordor

 

Happy reveries

Between flowers and the grass

Lazy dog just blinks

Past the nights of fear

Strife and strain ebbing away

White doves in the sky

http://chevrefeuillescarpediem.blogspot.de/

Carpe Diem's Revise that haiku #2, Basho's famous 'old pond'

Rain falls into pond

Tears of ancient sorrows

Frog leaves 

Windy night

Moon hovers above the pond

Frogs won’t jump

The muddied pond

They only jump after sunset

These lazy frogs

http://chevrefeuillescarpediem.blogspot.de/

Carpe Diem's Tan Renga Challenge Month #VIII, MMT's ''even candent days''

 

even candent days

cannot drive the willow leaves

from their homing place

Magical Mystery Teacher

silence is called golden

leaves fall silently

the wind talks loud and louder

but leaves keep their silence

http://chevrefeuillescarpediem.blogspot.de/

PS. Will be on vacation during the next weeks, most probably the last entry before returning from New Zealand.

Influence of Weather on Rheumatoid Arthritis Disease Activity

It's still a big question, but we're getting closer to an answer. People with rheumatoid arthritis often complain about the influence of weather an disease activity. There were two studies at the ACR 2013 Meeting in San Diego addressing the issue.

T. Sawada and colleagues presented the following study [Abstract #1356]: "Disease Activity Of Rheumatoid Arthritis Is Influenced By Seasonal Change, As Analyzed Based On a Nationwide Japanese Cohort Database." This study looked more at seasonal variations than weather and found, that "RA disease activity, as assessed both subjectively and objectively, was lowest in fall." Sorry, that won't get us any further, though one would have to take this account, when doing studies in Japan.

E. Savage and colleagues presented the second study [Abstract #1359]: "Does Rheumatoid Arthritis Disease Activity Correlate With Weather Conditions?" The authors come mostly from Belfast, Northern Ireland, but one also from St. Vincent’s Hospital, Melbourne, Australia, where I had the pleasure to do some research on DRGs. I guess that the data has been collected in Belfast. 133 patients either on stable etanercept or adalimumab were recruited for this study. The authors lokked at "three weather components from the seven quantitative variables (maximum temperature, minimum temperature, hours of sunshine, mm rainfall, relative humidity, wind-speed and pressure)." Conclusion: "This study demonstrates statistically significant lower DAS-28 scores in sunny and dry conditions. A non-significant trend to higher DAS-28 scores in times of low temperature, and dull, wet and windy weather was also noted." I'm surprised to hear about sunny and dry weather in Belfast, but now we have statistically significant results that prove patients complaints.

Weather and inflammatory rheumatic diseases

It is not uncommon that patients with rheumatic diseases report an increase of symptoms under certain weather conditions. Some of my patients feel that it will rain soon based on their symptoms. Other patients with rheumatoid arthritis report that cold, wet weather conditions or changes in air pressure will worsen their symptoms, such as pain, stiffness or joint swelling.

The results of studies on the effects of weather on the rheumatoid arthritis haven’t been conclusive, but there’s a new study that proved a link between weather and symptoms, which has been presented at the ACR 2013 Meeting in San Diego. See link below.

Weather sensitivity - findings from the last few weeks:

"Not the weather itself, but the change no matter which direction leads to more complaints." (female, RA)

"If there’s a change in weather. But I don't know if it isn’t in the mind. If a rain front comes. When the sun shines, I feel better." (female., RA)

Weather sensitivity: no (female, PsA)

"Maybe it was because poor weather. I thought the heat was really agreeable. You can’t always blame the weather. If it wouldn’t come so suddenly, but if the temperatures would go down gradually, so peu à peu." (female, RA)

"The cold and wet weather is not conducive. But it's then not particularly severe. The warm weather is good to me, I don’t get not much flares." (female, AS)

"Really bad. Such a weather [wet, cold] is fatal." (female, AS)

"Sweating in hot weather, nothing else." (female, RA)

"Since the weather swings back from warm to cold, I have more complaints again. But maybe I just feel it in my head.” (male; RA)

Weather sensitivity: "I'd say no." (male; RA)

"It depends on the weather. If it’s wet and cold, I've got more complaints again. I notice 100%, if the weather turns." (female, RA)

"I immediately notice the change in the weather in my back." (male; PsA)

"There is a comfortable temperature. It should be not too hot and not too cold." (female, RA)

"The hands are swollen since the change in the weather. More fatigue. More sluggish. As usual, when the weather swings." (female, SLE)

"With the change in the weather last week I put on a splint, because the whole right hand hurts very badly. I’ve put the hand immediately at rest. Then again, the next day, it's alright. I can tell you, if it's hot, because then my right little finger points to the outside of my hand." (female, RA)

"When it rains, or when the weather changes, the pain gets stronger." (male; AS)

"With the rain, it's worse. I have more pain if it’s damp. (female, RA/SLE)

"I had the feeling for the first time that it is related to the weather. I've never experienced  t this way. The rain." (female, RA)

"It has to be the humidity. Saturday was my date for the injection, I noticed it two or three days before." (female, RA)

"I'm always weather sensitive. More problems with damp and cold weather. Even in air-conditioned rooms. Running is more difficult and breathing, and my heart is racing." (female, RA plus lung involvement)

"Since Thursday I have more complaints on the back. The rain, the cold." (female; RA)

"Complaints from time to time. Once the moisture hangs out in the air." (female; AS)

"In the rain all joints hurt. In wet weather, I notice it immediately, then I can not run. In the summer, it is better. Now it hurts everywhere." (female; RA)

"Especially now with the weather [it’s worse again]. Before the weather change arrives. The other day we have rain. Then I can not sleep." (male; PsoA)

"When the weather change comes, if it gets wet, when the extreme weather change comes, then stiffness lasts much longer; then, you don’t want to put the elbow onto somewhere. No matter whether it turns from good to bad or vice versa." (male; RA)

"Last change in the weather a fortnight ago led to a swelling under my right foot, lasted 2 and 2½ days. Cooling with ice also didn’t help. Right hand starting from the outer edge, until it covered the entire hand." (male; RA)

"When it gets so cold, I've always cold hands; feet also." (female; RA)

(RA - Rheumatoid arthritis, PsoA - psoriatic arthritis, AS - ankylosing spondylitis, SLE-Systemic Lupus Erythematosus)

When the weather is particularly rainy and cold weather seems to increase joint pain and stiffness. But there are lots of differences.

Here’s the link to the blog post on the ACR 2013 Meeting: http://rheumatologe.blogspot.de/2013/11/influence-of-weather-on-rheumatoid.html

Carpe Diem's Tan Renga Month #V, Sara McNulty's "Life completes circle''

 

life completes circle

at the end of the journey

death draws the last line

Sara McNulty

gloomy words on epitaph

butterflies fly by and rest

between abodes of death

a creeper finds place to bloom

http://chevrefeuillescarpediem.blogspot.de/

Mavrilimumab at the ACR 2013 Meeting in San Diego

Mavrilimumab is a human MAB for the treatment of rheumatoid arthritis. It targets the GM-CSF receptor-alpha. More at: http://en.wikipedia.org/wiki/Mavrilimumab

Usually we are talking about T and B cells in rheumatoid arthritis or maybe dendritic cells, but now neutrophils and macrophages come into focus. GM-CSF controls activation, differentiation, and survival of macrophages and neutrophils.

I've just been to an ACR review/update course here in Germany and the colleagues were very much in favour of this new drug.

There have been three studies on mavrilimumab at the ACR 2013 Meeting in San Diego.

G.-R. Burmester and colleagues presented the following study [Abstract #1733]: "Early and Sustained Improvement In Pain and Physical Function As Measured By Visual Analog Scale and Short Form-36 Physical Component Summary Score In Rheumatoid Arthritis Patients Treated With Mavrilimumab, An Investigational Anti-GM-CSFR-Alpha Monoclonal Antibody, In a Phase 2a Study." Conclusion: "Treatment with mavrilimumab 100mg resulted in an early onset and sustained improvement in pain relief and physical functioning as measured by VAS and SF-36 PCS, respectively, in moderate-severe RA patients. These findings are consistent with improvement in the disease activity (DAS28-CRP) and support further investigation of the blockade of the GM-CSF receptor with mavrilimumab in Phase 2b studies conducted in both DMARD-IR and TNF-IR patients."

W. White and colleagues presented the second study [Abstract #2377]: "Biomarkers Associated With Rheumatoid Arthritis Disease Activity Including Joint Damage Correlate With Changes In Clinical Response In Subjects Treated With Mavrilimumab At Doses Above 10 Mg." Conclusion: "Promising clinical safety and efficacy results of mavrilimumab support further clinical development at doses greater than 10 mg. Mechanistically, the drug suppressed both acute phase and inflammatory blood markers. Tracking of disease activity by MBDA showed a clear biomarker-based dose-response relationship. The association of MBSD decline with radiographic damage will be assessed in an on-going phase 2b study."

But there hasn't been any data on radiographic changes up to now.

P.C. Ryan and colleagues resented a study on monkeys [Abstract #2378]: "Safety Of Mavrilimumab In Cynomolgus Monkeys: Relevance Of Nonclinical Findings In Lung To Human Safety." Conclusion: "These results suggest that suppressing macrophage activity by targeting GM-CSF receptor alpha may be a novel approach with an acceptable safety profile for the treatment of RA."

Interestingly in "results" the results of a study published at the EULAR 2012 Meeting in Berlin has been quoted: "In EARTH,

mavrilimumab demonstrated good clinical activity with no clinically significant or persistent changes in the lung function tests performed. Likewise, the serum biomarkers of lung damage, SP-D and KL-6, showed no clinically significant changes following mavrilimumab treatment." The study at the EULAR 2012 had been by S. Spitz and colleagues [Abstract AB0576]; "Evaluation Of Surfactant Protein-D And Kl-6 As Potential Pulmonary Safety Biomarkers During Mavrilimumab Treatment".

It is like in a detective story - the inspector frowns if someone gives an alibi without being asked for it. Though as macrophages are involved the side effects on the lung should be monitored.

The recent data looks much better than what has been presented last year, but still we lack a study of longer duration with data on radiographic progression. And as the studies EARTH explorer 1 and 2 look at other dosages (also 150 mg) and test against golimumab for 24 weeks, results on radiographic progression still have a long way to come.

Summing it up: it looks better for mavrilimumab than a year ago, but still we don't know if there's going to be a new drug.

Links:

http://rheumatologe.blogspot.de/2013/06/mavrilimumab-at-eular-2013-meeting.html 

http://rheumatologe.blogspot.de/2013/03/mavrilimumab.html 

http://rheumatologe.blogspot.de/2012/07/mavrilimumab-at-eular-2012.html 

Carpe Diem's Tan Renga Challenge Month #III "morning shimmer" by Bjorn Rudberg

morning shimmer

dew frosting on furze

a single leaf falls

Björn Brudberg

a yellow remnant of spring

while the furze is shivering

http://chevrefeuillescarpediem.blogspot.de/ 

Carpe Diem's Tan Renga Challenge Month #IV Becca Givens River Stones

river stones

caressed by flowing water

pale moon shines

Becca Givens

stars glitter on the river

until the morning rises

http://chevrefeuillescarpediem.blogspot.de/