Tuesday, July 3, 2018

Heart rate monitoring, pacing & ME/CFS

A good basic overview of heart rate monitoring is here:

Case study from the originators of the technique:

Research paper describing the approach (relatively technical & dense, but might be useful for sceptics!):

There is also a very supportive Facebook Group:
Not quite as active as a year ago when I got involved, but still good.  There is a wealth of knowledge in the posts and the files, but it can be hard to sort through ...  If you post a specific question you are likely to get a helpful answer.

As for heart rate monitors (HRMs), you have a few options. You need something that will set off an alarm when you go over a certain heart rate (50-60% of max HR, usually about 100bpm).  It's also useful if it is waterproof so it can be worn in the shower, which can be the highest exertion a CFSer regularly does (I sit down in the shower now to keep my HR down).

* most accurate and cheapest: chest-strap sensor (e.g. Polar H10), sync'ed via Bluetooth to your phone.  Chest straps are very accurate, but some find them annoying to wear all day.  I haven't used this method so am not sure what apps are available that will sound an alarm when you go over a specified threshold.  You can also use a chest strap for advanced heart rate variability (HRV) monitoring.  HRV is used by athletes for identifying if they are over-training or not, and CFSers use it in a similar way.

* optical wrist sensors are incorporated into FitBit-type devices.  These are comfortable to wear 24/7, and also count steps and monitor sleep.  Optical sensors are not as accurate as chest straps, and can have quite a lag, which means they aren't very accurate when the HR is variable.  They also give bad readings when moving your fingers.  For this reason I wear mine on the ankle!  (Looks like a gaol bracelet, but then it kinda is ...  Also, you need slim ankles to do this.)  Having said that, I think they are accurate enough for our purposes. Can't be used for HRV though.  Polar now has a product designed to be worn on the upper arm, the OH1, but I'm not sure if it has a display or alarm (have to sync to phone).  I use a Polar a370 and am quite happy with it, though I have had to send it back twice for replacement (I think I've been unlucky).  Only the FitBit Ionic and Versa have an alarm, and FitBits have better sleep monitoring than other brands.  Also, someone has written a HR Pacing app which is available for FitBits!  Not sure if they are waterproof though.  Garmins are another option - some people use the Vivosmart 3.

Friday, June 1, 2018

Mould, CIRS, & ME/CFS

Now this is a can of worms.  There are two schools of though around mould: the Shoemaker Brigade, and the Mould Paranoids.

The Shoemaker Brigade follows the teachings/research of Ritchie Shoemaker, a doctor who has, over the past few decades, gradually developed the idea of Chronic Inflammatory Response Syndrome (CIRS).  Basically, he reckons that a subsection of the community is genetically susceptible to biotoxins (e.g. mould toxins, but also Lyme and algae), which they can't detoxify, and they develop a chronic inflammatory response which makes them Really Fucking Sick.  He reckons CFS actually is a sub-type of CIRS.  He has a set of criteria for diagnosis, including some blood tests, and a clear treatment protocol. However, there's not point treating it until you're not being exposed anymore, which requires testing your house for mould (which is another can of worms).  There are only a few Shoemaker-trained doctors in Australia (the main one is on the Sunshine Coast), and some of the most diagnostic blood tests aren't available in Australia (but they can't be sent there for $$$s).  The evidence base for all of this is not terrible (they have a few decent peer-reviewed papers), but it's mostly from the one group of researchers, and some of the assertions aren't well documented (though others are).  I've been thinking of writing up something to summarise everything I've learnt on my mould journey, as it's hard to find solid information.

I've attached a couple of documents that give a detailed overview of CIRS [1, 2].  Let me know if they are too much and I can find something simpler.  Also worth a look is the http://www.toxic-mould-support-australia.org/ website, which is pretty good and has a strong community behind it, which you can find on Facebook.  Though the CIRS crowd seems to have more nutcases in it than the CFS crowd!

Which brings me to the Mould Paranoids, who think that things are much worse than even Shoemaker thinks.  They practice extreme mould avoidance, and experience significant symptoms whenever they go into a mouldy building.  They find that they react to items that have been in a building, and the effect can takes years to wear off - many items cannot be remediated at all. Some people go to the extent of throwing out all their things and starting from scratch in a new house.  This all started with Erik Johnson, who was got CFS in the Incline Village epidemic in the 80s.  He found that he felt better in certain places, and using some toxin-avoidance protocols he learnt in the army, he worked out that the problem was mould exposure.  You can read about his story and how to practice mould avoidance here: http://paradigmchange.me/erik/

This all sounds pretty wild at first, but there is a strong community of people who go to great lengths to stay mould free, and that is probably only because it actually works for them.  One way to work out if this is your issue to to go on a Mould Sabattical: go to the desert for a few weeks, with *none* of your current belongings.  If you feel better, or crash big-time when you return, then mould might be a problem for you.  There is a guide on this here: http://paradigmchange.me/avoidance/  This is all pretty challenging for sciencey types like us, and the article below does a brilliant job of exploring the issue. It's written by a science writer, and she even does a double-blind experiment to prove that she actually is responding to items from her house.

I'm open to the mould hypothesis because I first got sick shortly after spending a few nights in a very mouldy caravan, and I later spent more time in another caravan and tent which could have been mouldy.  On the flip side, most of the time I've been in Hobart I was gradually improving, and was living in a dodgy rental that had obvious roof leaks and mould damage (though was very well ventilated).  But then I started going downhill and relapsed after moving into our own place, and I have identified a couple of mould problems here (one of which we've fixed, the other I just found (mouldy roof beams!)).  It's a slow jounrey working my way through all of this, but I'm gradually getting less panicked about it and just doing the best I can.

Thursday, May 17, 2018

CFS tips

From a conversation I had with an acquaintance who has recently been diagnosed with CFS,. He asked for some tips, and I gave him a brain dump ...

I'm not able to work at the moment. I was gradually going downhill while I was at TIA in 2016. When my contract ended I kind of collapsed over the line and didn't bounce back like I expected. So I've been largely stuck at home doing my best to manage it. I've seem to have successfully stopped the backsliding, turned the ship around (it;s a bloody big one!) and seem to be headed in the right direction now. But I don't do much productive, and certainly can't be relied on. I'd say I'm 30% on the CFIDS scale:
I first got sick 10 years ago, and this is my first major relapse in that time. Until then, I was gradually getting better and could maintain a 50% workload. By the end of 2015 I was even doing some bushwalking and living a fairly full ife. But then we bought a house and I started working 3 days a week and I gradually dug the hole deeper. I always thought relapsing would be the worst thing that could happen, but it's much easier the second time around - my wife and I have learnt a lot!
Sounds like you've done a fair bit of research and learning yourself, so im not sure how much detail to go into. Maybe I'll just outline the things that I have found most useful and we can delve into things more deeply if you're interested.
DIAGNOSIS: You've probably been through this already, but it's worth making sure you've excluded all other possibilities. Depending on your doctor this may not have been done very thoroughly. I quite like the IACFS/ME Primer which includes the Canadian Consensus Criteria and a good guide to treatment options: http://iacfsme.org/portals/0/pdf/Primer_Post_2014_conference.pdf
PACING is by far the most important mainstay of managing CFS. The principle is simple enough but it's bloody hard to do well. The biggest challenge is working out what your energy envelope is, and whether or not you've gone past it - you can't rely on your body to tell you when that is - once you're tired, it's WAY too late.

Using a heart rate monitor has made my pacing massively more effective. I can now put an objective number on my envelope (in terms of the number of minutes I spend above 100bpm in a day). I have also been able to model how my HR effects my fatigue. So if I overdo it today, then I will start feeling it in 3 days' time, with the worst on days 4 and 5. This is nothing short of a revelation! 🙂 For years I knew I had at least a day's lag between exertion and payback, but it wasn't until I started collecting detailed HR and symptom data that I could tease out the full picture.

So now I wear my HR monitor religiously, and it vibrates whenever I hit 100bpm (which doesn't take much), so I know I need to ease back and take a break. I rarely crash hard anymore, which I think is key to gradually getting out of the CFS hole.
When I'm managing my pacing well, my symptoms are minimal - I actually feel fairly normal. The trick is to no then overdo it! The HRM is a constant (unremitting, infuriating) reminder of my actual limits. Which means I probably do less than I would without it, but I am much more stable and I think ultimately happier and healthier.
A side note to the heart rate stuff is to explore if you have some form of orthostatic intolerance. This is a common co-morbidity with CFS and basically means you have trouble standing for periods. I have borderline POTS, which means my HR is much higher while standing than is normal. This makes it harder to stay within my HR limits. Orthostatic intolerance isn't very well understood but is probably to do with low blood volume and a screwy autonomic nervous system. There are ways you can treat it (at least partially). You can self test for POTS doing the standing lean test: https://www.healthrising.org/forums/resources/a-simple-test-for-orthostatic-intolerance-in-chronic-fatigue-syndrome-and-fibromyalgia-the-nasa-way.388/
SLEEP is super important, and often screwed up in CFS. Being 'tired but wired' can make it hard to get to sleep, and it's common to wake up raring to go at 4am. Valarian and melatonin are good sleep aids, but they don't help with the 4am problem. I saw a sleep specialist and he put me on a low dose of mirtazapine which has helped my sleep heaps. It also is an anti-anxiety drug and has reduced my POTS a bit. CFS doctors seem to use sleep meds fairly liberally.
Thankfully I haven't had much in the way of PAIN, so can't advise. I get achy legs and sometimes a killer tight neck but nothing nasty like fibromyalgia.
I also haven't had major issues with BRAIN FOG, so I can mostly read, write & think without too much trouble. But I think I am lucky here. I do get mood swings though, and was quite depressed/anxious for the first few years. Effective pacing and a low carb diet keep this under control.
DIET has a big effect for many with CFS, though there is a lot of variety as to what works for different people. I'm super-sensitive to sugars and carbohydrates - they make me anxious and irritable and give me burning abdominal pain. My current diet is sugar, fruit, potato, grain and legume-free. So I eat a lot of vegies, protein and fat. Dark chocolate is my treat. Low-ish carb seems to work for a lot of CFSers, so it's worth a try. Other diets to consider are: 
* low FODMAP (if you have IBS) 
* low allergy diet (from RPAH)
* ketogenic diet
* Autoimmune Protocol (AIP) - I plan to try this one day as there is mounting evidence for autoimmune (I have psoriasis too) and gut conditions, but it is pretty extreme.
NEUROLOGICAL: It could be worth getting some counselling to help deal with the trauma of chronic illness. I meditate daily to try and keep my sympathetic nervous system under control. When I first got sick I did the Gupta Amygdala Retraining Programme, which is semi-woo woo, but it was the first time I encountered a practitioner who totally understood the condition, and it definitely helped me break out of my obsessive sickness mindset, which took a layer off the top of the illness (but didn't get to the underlying problem.)
SUPPLEMENTS: I take a lot of supplements, though their value is questionable. I did a lit review a while back and identified all the ones that had some evidence. From memory they were: CoQ10, NADH, magnesium, acetyl-l-carnitine, n-acetyl cysteine. Other supps worth trying are zinc (really helped me with getting viruses all the time), D-Ribose, vitamin D and the B vitamins. I recommended trying things one at a time and keeping good record of your symptoms so you can identify which you tolerate and if they help or not. I can't take CoQ10, NADH or B vitamins - they all make me wired.
After this, you're getting into less certain territory. But that's the reality of this illness - not a lot of research or good evidence to work with. So treat yourself as a n=1 experiment and see what works for you. Things worth looking into are: 
* gut health/dysbiosis
* anti-virals (Valcyte etc) 
* low-dose naltrexone 
* Chronic Inflammatory Response Syndrome (aka toxic mould. Possibly dubious, but there may be something to it) 
* Lyme disease (if it fits) 
But in my view all of these things are hopes, something to pursue but not count on. Don't waste your life trying to find a cure - allocate some time to it but don't obsess over it. Focus on what you know works, manage yourself well and try to live the best life you can within those constraints. It's a shit of an illness but you can learn to control it.
EXERCISE: sounds contradictory, especially with all the rage about the PACE trial and CBT/GET, but there's place for it. The key is to go very very slowly, and to stay within your heart rate boundaries. I've been seeing an exercise physiologist who has a lot of experience with CFS. I am now doing free weights for upper and lower body - I do exercises that isolate one muscle at a time (to minimise stress) and which are prone or sitting (to minimise OI), lots of rest in between. I particularly enjoy the upper body weights and get a good feeling from it, as well as a little muscle tone My next step is to start doing more structured walking - short intervals with decent rests, but that is much more challenging HR-wise.

STRESS minimisation is key. Stress of all sorts: physical, mental, emotional. Sometimes just going to the doctor can get my heart racing all day, which can lead to a crash.  Having a solid routine is really helpful, and the less responsibilities the better (e.g. I occasionally cook dinner, but my wife never depends on me to cook, so there's no drama if I'm not up to it and I'm not tempted to push myself). When I've overdone it I can find it really hard to make decisions and it really stresses me out. We've developed a simple flowchart to help: Can I do X? If confidently Yes, then do it. If confidently No, then don't. If unsure, then don't. If I'm not sharp enough to make a decision easily then I need to back off. This takes the uncertainty out of life and is much less stressful.

Finally ... REST. Then rest some more. If in doubt, rest again. With this illness you will struggle to over-rest. Did I mention Rest?

Thursday, January 4, 2018

Books 2017

This year I tried to read more female books.  I was also sicker than I have been in a long time so I may have done more reading.  Let's see how the stats look.

74 books in total (compared to 56 in 2016, 43 in 2015).
Gender: Male 43%, female 51% (37% in 2016), joint 4%, other 1%.
Origin: Anglo 84%, non-Anglo 16% (9% in 2016)
Type: Fiction 81%, non-fiction 19%

So I did well at upping my female authors, and improved slightly on diversity of origin (although that would have been skewed by Elena Ferrante's 4 books).  

No 5 star books!

4.5 stars: 6 books (8%)
"No Is Not Enough" Naomi Klein. 4.5 stars. Trump is the end-product of a disastrous economic & political system. Pa… https://t.co/SqvPN5EEIX Thu Jan 04 02:00:50 +0000 2018
"Butcher's Crossing" John Williams. 4.5 stars. A gut-wrenching account of how man destroys that which nourishes him… https://t.co/gjNBWNbw4r Tue Dec 05 06:25:45 +0000 2017
"Doughnut Economics" Kate Raworth. 4.5 stars. A comprehensive and satisfying demolition of neoliberal economics. Pr… https://t.co/8mf4v2cDio Fri Nov 10 06:50:34 +0000 2017
"The Narrow Road to the Deep North" Richard Flanagan. 4.5 stars. The agony and pointlessness of it all. Tue Nov 07 04:48:26 +0000 2017
"All The Birds In The Sky" @charliejane Anders. 4.5 stars. Unpredictable, clever & funny. A wonderful creation. Sat Sep 16 08:52:12 +0000 2017
"The Spare Room" Helen Garner. 4.5 stars. The agony of illness and the grasping for health. So well portrayed it feels like it must be true. Mon May 22 02:25:52 +0000 2017

4 stars: 17 books (23%)
"How Did We Get Into This Mess?" George Monbiot. 4 stars. A selection of his finest articles, exploring the madness… https://t.co/SVMronWbis Thu Jan 04 02:15:28 +0000 2018
"The People of the Book" Geraldine Brooks. 4 stars. A fascinating journey through the history of European Jews, usi… https://t.co/yAkfZjP6aP Thu Jan 04 02:14:56 +0000 2018
"In Other Lands" Sarah Rees Brennan. 4 stars. Makes up for poor writing with great characters and relationships. Tu… https://t.co/QETC1VRYNN Thu Jan 04 02:00:15 +0000 2018
"The Bond" Simon McCartney. 4 stars. Two young bold climbers push the envelope in Alaska, and barely get away with it. Climbers are NUTS! Sun Dec 24 03:33:08 +0000 2017
"The Water Knife" Paolo N Bacigalupi. 4 stars. The water wars of the near future. A hint of Mad Max. Frighteningly possible. Fri Nov 10 06:42:12 +0000 2017
"Bring up the Bodies" Hilary Mantel. 4 stars. A well executed clusterfuck. Poor Anne Boleyn: well and truly screwed (one way or another). Tue Nov 07 04:50:32 +0000 2017
"Those Who Leave and Those Who Stay" Elena Ferrante. 4 stars. Realistic characters are so frustrating! Tue Nov 07 04:48:58 +0000 2017
"The Nature Fix" Florence Williams. 4 stars. We are wild beasts - get out there and soak it up. Sat Sep 16 08:50:39 +0000 2017
"My Life On The Road" Gloria Steinam. 4 stars. The power of community organising -inspiring! In the thick of so much transformative change. Sat Sep 16 08:42:11 +0000 2017
"Here Come The Dogs" Omar Musa. 4 stars. Fantastic use of language. Life on the other side of the tracks ... in Queanbo! Tue Aug 08 10:26:50 +0000 2017
"Still Lucky" Rebecca Huntley. 4 stars. If you need your faith restored in everyday Australians, read this. A good and visionary people. Tue Aug 08 10:10:21 +0000 2017
"Wolf Hall" Hilary Mantel. 4 stars. English history has never been so fascinating. Cromwell and an era brought to life with clarity. Wed Jun 21 11:38:01 +0000 2017
"The Bride Stripped Bare" Anon. 4 stars. A few major issues to deal with here. Pha-ew! Wed Jun 21 11:33:27 +0000 2017
"Tiny Beautiful Things" Cheryl Strayed. 4 stars. The best sort of agony aunt. So much wisdom and compassion on the trials of being human. Mon May 22 02:28:06 +0000 2017
"Postcapitalism" Paul Mason. 4 stars. An unexpectedly Marxist revelation. A valuable perspective on history. Capitalism in its death throes? Sat Mar 04 06:02:06 +0000 2017
"The Trowenna Sea" Witi Ihimaera. 4 stars. Brings a fascinating piece of history gloriously to life. A touch academic at times. Sat Mar 04 04:24:57 +0000 2017
"Burial Rites" Hannah Kent. 4 stars. The cold drift towards death ... Sat Mar 04 04:21:37 +0000 2017

3.5 stars: 19 books (26%)
"Updraft" Fran Wilde. 3.5 stars. A wonderfully fantastical creation - never mind the physics, just fly with it. Sun Dec 24 03:45:39 +0000 2017
"Sweet Thursday" John Steinbeck. 3.5 stars. A light-hearted comedy starring a tight-knit community of down-and-oute… https://t.co/jbe3IHiHjr Sun Dec 24 03:39:23 +0000 2017
"The Long Way to a Small, Angry Planet" Becky Chambers. 3.5 stars. A likeable bunch on a Red Dwarf-esque journey through the galaxy. Sun Dec 24 03:30:41 +0000 2017
"The New Republic" Lionel Shriver. 3.5 stars. Takes fake news to a new level. WAY before its time. Tue Dec 05 06:25:21 +0000 2017
"The Stone Sky" NK Jemisin. 3.5 stars. Gets pretty out there. I like the idea of a furious Father Earth bent on revenge. Tue Dec 05 06:24:21 +0000 2017
"Gut Reactions" Justin & Erica Sonnenburg. 3.5 stars. A good overview of the microbiome and its critical role in ou… https://t.co/jpvHi9Sszu Tue Dec 05 06:21:53 +0000 2017
"Luna: Wolf Moon" Ian McDonald. 3.5 stars. Sequel brings plot together making for a decent book. Fri Nov 10 06:43:21 +0000 2017
"The Power" Naomi Alderman. 3.5 stars. An old trope, power corrupts, but with a gendered twist. Brutally pessimistic. Lacks subtlety. Sat Sep 16 08:45:31 +0000 2017
"The Story of a New Name" Elena Ferrente. 3.5 stars. A finely woven tapestry of brutal men, trapped women and social immobility. Tue Aug 08 10:34:22 +0000 2017
"The Fifth Season" NK Jemisin. 3.5 stars. An intriguing world, but slow reveal of bigger picture left me dangling. Tue Aug 08 10:08:55 +0000 2017
"Daughter of the Empire" Raymond Feist & Jenny Wurts. 3.5 stars. Such a linear plot, but excellent comfort reading. Wed Jun 21 11:40:18 +0000 2017
"High Tide in Tucson" Barbara Kingsolver. 3.5 stars. A pleasurable ramble to dip into. Wed Jun 21 11:26:31 +0000 2017
"Salt Creek" Lucy Treloar. 3.5 stars. The brutal and beautiful reality of the Australian frontier. Wed Jun 21 11:19:29 +0000 2017
"The Lies of Locke Lamora" Scott Lynch. 3.5 stars. Rollicking tale of cunning and dastardly thieves. Wed Jun 21 11:08:51 +0000 2017
"Wild" Cheryl Strayed. 3.5 stars. One hell of a traumatic life. Nothing that a good long walk can't sort. Wed Jun 21 11:05:14 +0000 2017
"My Brilliant Friend" Elena Ferrante. 3.5 stars. Full immersion in the colour and messiness of of working-class Naples. Captivating. Mon May 22 02:32:36 +0000 2017
"The Heroes" Joe Abercrombie. 3.5 stars. War. Bloody realistic war. Sat Mar 04 06:00:29 +0000 2017
"The Mists of Avalon" Marion Bradley. 3.5 stars. The myth! The legend! The melodrama! Such tragedy! Very slow to get going, and overly long. Sat Mar 04 05:57:55 +0000 2017
"March" Geraldine Brooks. 3.5 stars. Brings a harsh dose of reality to the family of Little Women. Sat Mar 04 04:17:54 +0000 2017

3 stars: 23 books (31%)
"The Rapture of the Nerds" Cory Doctorow & Charles Stross. 3 stars. A quasi-dystopian comedy where humans have most… https://t.co/uIvZzjh6ry Thu Jan 04 02:11:25 +0000 2018
"Wired to Eat" Robb Wolf. 3 stars. Interesting ideas on ketosis and individual response to carbs. But written for dummies. Sun Dec 24 03:33:37 +0000 2017
"For Whom The Bell Tolls" Ernest Hemingway. 3 stars. Excessive detail and agonising pace in the buildup. Some horri… https://t.co/pkaMPLChuR Tue Dec 05 06:24:58 +0000 2017
"Best Served Cold" Joe Abercrombie. 3 stars. Blood begets blood, again & again. Decent characters though, if over the top. Fri Nov 10 06:44:28 +0000 2017
"The Story of the Lost Child" Elena Ferrante. 3 stars. Somewhat unsatisfying, but perhaps that's life. Fri Nov 10 06:43:57 +0000 2017
"The Japanese Lover" Isabelle Allende. 3 stars. A little charming but somewhat pedestrian. Lacks sparkle. Tue Nov 07 04:51:26 +0000 2017
"Luna: New Moon" Ian McDonald. 3 stars. Loved the moon world, but too many characters, too little resolved. Dynasties, really? Half a book. Tue Nov 07 04:51:00 +0000 2017
"The Obelisk Gate" NK Jemisin. 3 stars. Finally, some useful context. Losing its edge, though. Tue Nov 07 04:47:41 +0000 2017
"Lagoon" Nnedi Okorafor. 3 stars. Enjoyed the vibrancy of Lagos life, but a bit random. Sat Sep 16 08:49:52 +0000 2017
"Conservation Worrier" Jamie Kirkpatrick. 3 stars. Self deprecatory & funny. Surprisingly informative view of the conservation process. Tue Aug 08 10:31:23 +0000 2017
"Servant of the Empire" Raymond Feist & Jenny Wurts. 3 stars. More of the same, but more sex and less shine. Wed Jun 21 11:41:53 +0000 2017
"Seveneves" Neal Stephenson. 3 stars. Audacious premise and world-building. Undermined by some serious conceptual failings. Wed Jun 21 11:34:59 +0000 2017
"New York 2140" Kim Stanley Robinson. 3 stars. Cool concept, but translating the political challenges of 2010 to 2140 isn't credible. Wed Jun 21 11:24:48 +0000 2017
"The Wild Things" Dave Eggars. 3 stars. A fun flight of fancy, but what's it getting at? Probably nothing! Wed Jun 21 11:21:21 +0000 2017
"Middlemarch" George Eliot. 3 stars. Allegedly 'literature', but really just a big ol' soapie. For the period drama tragic. Wed Jun 21 11:16:24 +0000 2017
"Payback" Margaret Atwood. 3 stars. The many devious ways debt inviegles its way into our lives and cultures. Wed Jun 21 11:14:31 +0000 2017
"The Death Of An Owl" Paul Torday. 3 stars. Tried to be amusing, but ended randomly weird. Wed Jun 21 11:00:13 +0000 2017
"The Gift" Alison Croggin. 3 stars. Passable though largely derivative fantasy. Mon May 22 02:26:30 +0000 2017
"The Secret Chord" Geraldine Brooks. 3 stars. Great way to live some history. Sat Mar 04 05:59:32 +0000 2017
"Fight Like A Girl" Clementine Ford. 3 stars. Disturbing view from the trenches. Never thought of myself as an agent of the patriarchy! Sat Mar 04 05:58:52 +0000 2017
"The Daylight Wars" Peter Brett. 3 stars. Unremarkable fantasy. Sat Mar 04 05:56:49 +0000 2017
"44 Scotland Street" Alexander McCall Smith. 3 stars. Harmless but amusing. Sat Mar 04 04:22:22 +0000 2017
"Strandloper" Alan Garner. 3 stars. The story of William Buckley. A confusion of language, perhaps overly creative, but the vibe feels true. Sat Mar 04 04:15:49 +0000 2017

2.5 stars: 7 books (9%)
"Anything is Possible" Elizabeth Strout. 2.5 stars. Vaguely engaging vignettes about boring small town people. Perh… https://t.co/UeluCGq9pL Sun Dec 24 03:46:15 +0000 2017
"Red Country" Joe Abercrombie. 2.5 stars. Another fantasy-western. Doesn't particularly benefit. Fri Nov 10 06:47:11 +0000 2017
"Territory" Judy Nunn. 2.5 stars. Fluff, but readable. A bit lame really - awfully contrived. Sat Sep 16 08:46:17 +0000 2017
"Three Moments of an Explosion" China Mieville. 2.5 stars. Some impressive feats of imagination, but often left me wondering, 'Why?' Sat Sep 16 08:43:23 +0000 2017
"God Help The Child" Toni Morrison. 2.5 stars. Not sure of it's point, and unnecessarily odd. Mon May 22 02:29:11 +0000 2017
"The Skull Throne" Peter Brett. 2.5 stars. Fine, but could get on with it a bit! Sat Mar 04 04:19:18 +0000 2017
"Heroes of the Frontier" Dave Eggars. 2.5 stars. Not sure of its point? And such poor outdoors decision making! Sat Mar 04 04:13:35 +0000 2017

2 stars: 1 book (1%)
"The Terranauts" TC Boyle. 2 stars. Strange lame sci-fi soapy mongrel. Some basis in reality though! Sat Mar 04 04:16:28 +0000 2017

1.5 stars: 1 books (1%)
"The Low-Carb Fraud" T Colin Campbell. 1.5 stars. Comes across more as a frothin' vegan than as an objective scientist. Sat Mar 04 04:23:12 +0000 2017

Thursday, March 16, 2017

CFS Treatment Primer - first attempt

The first step is to be sure of what you are treating.  There have been a number of definitions for ME/CFS over the years.  ME is Myalgic Encephalomyelitis, and CFS is Chronic Fatigue Syndrome.  Some patient advocates reckon there is a difference between the two, but I've never been clear on the exact details on that.  In the literature, the two are considered the same and the term ME/CFS is used.

There are two recent criteria for diagnosing ME/CFS:
1. International Consensus Criteria http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full
2. Institute of Medicine (IOM):

These are well worth a read.  The main stand-out symptom is Post-Exertional Malaise (PEM), which seems to be unique to ME/CFS.  But there are a bunch of other common ones such as brain fog, stimuli sensitivity, muscle pain, POTS/OI, swollen glands, digestive issues, disrupted sleep etc etc etc.

There have been a bunch of research breakthroughs in recent months.  Some highlights which are worth familiarising yourself with are:
* Hypometabolic state:
* Pyruvate dehydrogenase
* Calcium ion channels:
* Pyruvate kinase:

My rough explanation for what seems to be going on: the body undergoes some combination of stresses (infection, mental, gut, toxicity) and enters a hypometabolic state to protect itself.  Due to a number of genetic/epigenetic predispositions (mitochondrial, methylation, autoimmune), the body gets stuck in this state, with a dysfunctional aerobic energy metabolism.  Limited energy production has fall-out all over the place, particularly the gut and the nervous system which are major energy consumers. These dysfunctions may serve to maintain the disease condition.

There are a few CFS doctors that share their knowledge.
1. Ros Vallings has published probably the best and most comprehensive mainstream book on treating CFS, "Diagnosis and treatment of ME/CFS".
2. Jacob Teitalbaum, author of Fatigued to Fantastic.
3. Sarah Myhill has a very detailed website with lots of detail on her treatment approach. She seems fairly alternative and has rubbed the authorities up the wrong way ...
4. Chris Kresser doesn't specialise in CFS, but I really like his approach to medicine (holistic but evidence-based).  He has a great blog and podcasts.


This is the most effective treatment there is for CFS, though it is more of a management strategy.  The premise is to work out your "energy envelope" and then not to exceed that.  Sounds simple, but it's actually feckin' hard to do.  The first reason is the your energy envelope on any given day way vary.  The second is that you have no timely feedback to indicate when you've gone outside your envelope.  Post-exertional malaise doesn't kick in until 24-48 hours after the exertion, so you don't know until it's (way) too late.

A recent development is to use heart rate monitoring to aid pacing.  The idea is that you need to avoid using your aerobic energy metabolism (coz it's broke, see above).  So you work out you threshold (roughly 60% of max heart rate) and do your best to stay below that.  This seems to work well for a subset of patients, particularly the more seriously ill ones. An extension of this is to measure heart rate variability (HRV), which is an indicator "vagal tone", or of how well your autonomic nervous system is working.  If you have overdone it then your HRV will be low, and you should take it easy.  Athletes use this to manage over-training.  Seems good in principle but in practice it doesn't seem to be so clear cut.

Second on the list of effectiveness is meditation.  This probably works because it calms the autonomic nervous system, which tends to be overwrought in ME/CFS.  I have started doing a thing called "coherent breathing" which is a way of breathing which increases your HRV - 5 seconds in, 5 seconds out.  It leaves me feeling much calmer than meditating usually does, and I find it easier to do.

Apparently CFSers have "sluggish lymph" and can benefit from treatments that help get the lymph moving.  I have had both manual lymph drainage and craniosacral therapy and am totally knocked out for a few days by both (in a good way).  So something is going on, and I like to think it is a good thing (clearing out toxins etc).  Craniosacral therapy is a pseudoscietific though ...

Third on the list of effective treatments in something called the Perrin technique, which is a form manual lymphatic drainage specifically for treating CFS.  My mate Phil is going to learn how to do it in May, so I'll let you know what I discover.

CFSers have very poor sleep which is a major barrier to recovery. Good sleep hygiene is critical.  I snore and intend to get a sleep study done to exclude sleep apnea and see if there's anything else that can be done.

CFSers spend a lot of time messing with their diets.  There is no one answer, but many benefit from a low-carb diet.  Others find avoiding certain food chemicals to be helpful.
* Paleo Autoimmune Protocol
* FODMAP avoidance - particularly for IBS
* RPAH Elimination diet - salicyclates, amines, glutamates
* low-oxalate diet

It's hard to say if dysbiosis and/or intestinal permability is a cause of CFS or a result of another mechanism (e.g. hypometabolism).  But it seems reasonable that treating it would improve nutrient absorption and reduce inflammation, which may help the body heal itself.

POTS (Postural orthostatic tachycardia syndrome) and OI (orthostatic intolerance) are common problems for a subset of CFSers.  This seems to be tied to autonomic dysfunction.  Treatments are drinking lots of electrolyte, eating lots of salt, compression stockings and blood pressure medication.

My resting heart rate is about 55bpm.  When I stand up it shoots up to 105bpm but comes down to about 80 within a few minutes.  I don't think I would qualify for POTS because the high heart rate isn't sustained, but would be close (I intend to get this checked out by a GP).  I don't think my blood pressure is too much of a problem (rarely get dizzy). In any case I have been making my own electrolyte drinks and adding lots of salt.  Once it cools down I will try some compression stockings or Skins.

This is a treatment approach many CFSers have pursued, though it may just have been flavour of the month. Having said that, I think recent research is showing that CFSers have a greater number of SNP mutations than normal in these areas.  I've had the 23andMe test done and have a couple of important homozygous mutations (MTHFR 1298 and CBS), but I think I need to get further tests done to work out if these are actually causing a problem.  Useful tests are homocysteine and organic acids - anything else you recommend?  This is quite the rabbit hole to go down ...  I have tried B12, 5-MTHF and a few other things but found they just made me wired.  I think I have been approaching this blind and need more hard numbers to work with, and an expert wouldn't go astray!

Some research has shown benefit from treating patients with anti-virals, with the theory being that we have viruses that aren't active in the blood, but elsewhere (e.g. spinal cord, vagus nerve, gut).  One study treated EBC, CMV and HHV-6:
Another doctor has been using oxymatrine as an anti-viral with some success:

Cancer researchers in Norway found that Rituximab has been effective at treating CFS.  THey are doing clinic trials at the moment.  It kills B-cells, of which there can be too many in CFS.

Lyme disease is a bit controversial in Aus, but there are doctors treating for it.  People with CFS sometimes turn out to have Lyme, or something Lyme-like.  Treatment is a shitload of antibiotics for a long time, which is expensive and seems risky!  I've had a test for Lyme, but not the one from the US which is supposedly more sensitive. 

There are other chronic bacteria infections that might be an issue for CFSers (e.g. Mycroplasma).

Amygdala retraining
There are neurolinguistic techniques that attempt to retrain the brain out of it's chronically wired mode.  I did the Gupta AMygdala Retraining programme about a year into my illness and found it helpful for breaking out of the sickness mentality (obsessing about symptoms etc).  Beyond that I doubt that it gets to the cause of the illness.  There have been a few small studies that show some benefit.

Exposure to toxins may be a trigger in some CFS cases, and detoxification can be impaired in those with CFS.  Heavy metals and mould are two prime candidates, though there are plenty more nasty chemicals out there.  Some people with CFS develop Multiple Chemical Sensitivity (MCS) which means they have to avoid *everything*.  One approach in CFS is to move to the desert and replace all your clothes to avoid mould!

I haven't been tested for heavy metals (except for lead).  What would be the best test for this?  Also, do you know anything about testing for mould?  I was exposed to mould just before I got sick, and our rental at Wellesley St had a leaky roof with mould problems.

Lots of supplements used by CFSers aim to provide mitochondria support, and have some research bonafides  Ones that come up often are CoQ10, D-Ribose, NADH, Acetyl-carnitine.  I've tried some of these but not sure if all at once.

Thyroid and adrenals
These often have problems, though again I suspect they are the result of an underlying problem rather than the cause.  Hypothyroidism is common, and "adrenal fatigue" gets a lot of attention (though I'm not sure is that is a proper disease or not).  My thyroid isn't perfect: good TSH, free T4 and free T3 (even according to tighter "alternative" ranges) but my reverse T3 is high and I have TPO antibodies.  My reading suggests that the reverse T3 could be due to high stress (which is a given with CFS).  The TPO antibodies could be because my Mum has Hashimoto's, and apparently that can show up in my antibodies.  I take iodine and selenium to provide support for my thyroid, and have tried tyrosine before.  I've also has DHEA-S tested, which was fine, but haven't done cortisol.  I think it is best to do a 24 hour cortisol/DHEA test to pick up adrenal dysfunction.

Copper and pyrroles
I don't know much about this, but see it mentioned from time to time on the forums.  Not sure how much evidence there is for pyroluria?

Saturday, March 4, 2017

Books 2016

Here are the books I read in 2016 - there were 56 of them.  I'm pretty sure my ratings are getting tougher as time goes on.

20.5 of them were by female authors (37%).  5 were by non-white authors (9%).  Got some work to do to bring some diversity to my reading!  This year I am aiming for 50% female authors.

5 stars: 2 books (4%)

"Talking to my Country" Stan Grant. 5 stars. Must read for all Australians. Heart-breaking insight into being Indigenous. Tue Nov 29 07:42:47 +0000 2016
"Lighter than my Shadow" @KatieGreenBean. 5 stars. Gut-wrenching account of a journey through anorexia. Illustrations captured emotions. Wed Feb 03 10:26:02 +0000 2016

4.5 stars: 2 books (4%)

"The Art of Frugal Hedonism" Annie Raser-Rowland & Adam Grubb. 4.5 stars. How to live the good life on the cheap. Escape the grind! Mon Jan 30 10:13:16 +0000 2017
"Cloud Atlas" David Mitchell. 4.5 stars. Extraordinary scope and intricacy. Full meaning just out of grasp, but brilliantly told. Fri Sep 02 01:22:31 +0000 2016

4 stars: 13 books (23%)

"The Fool's Assassin" @robinhobb. 4 stars. Aaaah, so good to be back with Fitz and the Fool. Like a warm bath ... Tue Nov 29 07:50:02 +0000 2016
"Sapiens" Yuval Noah Harari. 4 stars. Concise and perceptive history of humankind with some valuable perspective on the here and now. Fri Nov 18 02:55:27 +0000 2016
"Grow A Little Fruit Tree" Ann Ralph. 4 stars. The best explanation I've read on how to grow and prune a fruit tree for the backyard. Sat Nov 12 04:38:46 +0000 2016
"The Spirit Catches You And You Fall Down" Anne Fadiman. 4 stars. Fascinating account of culture clash, marvellous insight to the Hmong. Sat Nov 12 04:30:36 +0000 2016
"The Mandibles" Lionel Shriver. 4 stars. Post-financial apocalyptic - a new genre? Brings intangible ideas home. Mon Oct 24 10:11:36 +0000 2016
"Ghostwritten" David Mitchell. 4 stars. Similar, though less complex, structure to his later Cloud Atlas. Varied and unexpected. Mon Oct 24 10:15:52 +0000 2016
"Tehanu" Ursula Le Guin. 4 stars. Interestingly, I preferred the Tenar stories over the Ged ones. More intimate, less epic. Fri Sep 02 01:20:16 +0000 2016
"Day of the Triffids" John Wyndham. 4 stars. Eerie & gripping apocolyptica. Shows the existential worries of the post-war years. Tue May 31 10:15:08 +0000 2016
"Puberty Blues" Gabrielle Carey & Kathy Lette. 4 stars. If you thought kids & sex was a modern problem, read this. Some messed up stuff. Tue May 31 10:12:01 +0000 2016
"Aurora" Kim Stanley Robinson. 4 stars. Great tale of interstellar colonisation, with a strong lesson: there's no place like home. Tue May 31 10:08:00 +0000 2016
"Hyperion" Dan Simmons. 4 stars. Very effective narrative approach gradually reveals depth and weirdness of author's universe. Sat Apr 23 09:52:17 +0000 2016
"Wizard of Earthsea" Ursula Le Guin. 4 stars. Wonderful formal storytelling tone rarely used today. Sat Apr 23 09:49:37 +0000 2016
"Postcapitalism" Paul Mason. 4 stars. An unexpectedly Marxist revelation. A valuable perspective on history. Capitalism in its death throes?

3.5 stars: 15 books (27%)
"Fool's Quest" @robinhobb. 3.5 stars. Moves a bit slowly - could do with some tighter editing. Tue Nov 29 07:51:10 +0000 2016
"All That I Am" @annafunder01. 3.5 stars. The pain of watching your world fall apart. Touch wood ... Tue Nov 29 07:48:42 +0000 2016
"Z for Zachariah" Robert O'Brien. 3.5 stars. Nuclear apocalypse, self-sufficiency and an abusive over-bearing man. What's not to like? Sat Nov 12 04:46:19 +0000 2016
"The Amber Spyglass" Philip Pullman. 3.5 stars. A pleasing conclusion to the trilogy. Really pushes the fantastical side of the world(s). Mon Oct 24 10:18:01 +0000 2016
"Econobabble" @RDNS_TAI 3.5 stars. As always, Dennis cuts to the core of econo-speak. Must-read to understand what they're really saying. Mon Oct 24 10:09:04 +0000 2016
"The Subtle Knife" @PhilipPullman 3.5 stars. A step up in complexity, with the greater narrative becoming clear. Thoughtful inventive ideas. Fri Sep 02 01:28:59 +0000 2016
"The Wolf of Wall St" Jordan Belfort. 3.5 stars. Disturbing insight into the depraved meaningless lives of ultra-rich stock manipulators. Tue May 31 10:03:40 +0000 2016
"A Single Man" Christoper Isherwood. 3.5 stars. Well written - a pleasure to read. Not sure I got caught up in it's main message, though. Sat Apr 23 10:01:59 +0000 2016
"Flying Hero Class" Thomas Keneally. 3.5 stars. Great effort getting inside heads of aeroplane hostages. Some disturbing psychology! Sat Apr 23 09:57:44 +0000 2016
"The Tombs of Atuan" Ursula Le Guin. 3.5 stars. Much more intimately told than first book. Works well but lacking in scope. Sat Apr 23 09:54:02 +0000 2016
"Northern Lights" Philip Pullman. 3.5 stars. Enjoyable rollick through a magical Earth, with some confronting ideas. Sat Apr 23 09:48:01 +0000 2016
"Australia's Second Chance" @GMegalogenis. 3.5 stars. Hard sell on the value of migration, but assumes economic growth must (and can) go on! Sat Apr 23 09:45:45 +0000 2016
"The Book Thief" Markus Zusak. 3.5 stars. Use of Death as narrator was a bit awkward, but a touching story from Nazi Germany. Sat Apr 23 09:39:15 +0000 2016
"The Heroes" Joe Abercrombie. 3.5 stars. War. Bloody realistic war.
"The Mists of Avalon" Marion Bradley. 3.5 stars. The myth! The legend! The melodrama! Such tragedy! Very slow to get going, and overly long.

3 stars: 13 books (23%)
"The Gunslinger" @StephenKing. 3 stars. Trippy. Might have to read a sequel or two to decide if I like it. Mon Jan 30 10:21:25 +0000 2017
"The Alloy of Law" @BrandSanderson. 3 stars. Creative re-use of a fantasy world (he went Western). Lots of action, perhaps too much. Mon Jan 30 10:19:30 +0000 2017
"The Last Days of New Paris" China Mieville. 3 stars. Surrealism a bit beyond me, but the fascinated by the implications of the afterword. Mon Jan 30 10:16:14 +0000 2017
"Momo" Michael Ende. 3 stars. A bit eerie, and a good reminder to BE, not to DO. Wed Nov 30 22:25:18 +0000 2016
"Lab Girl" Hope Jahren. 3 stars. Scientists are crazily obsessed, and this one more than most. Paints a bleak picture of the research world. Sat Nov 12 04:35:57 +0000 2016
"Extreme Money" Satyadit Das. 3 stars. Detailed,disturbing expose of the dodgy workings of the financial system. Long-winded and scattered. Tue May 31 10:06:25 +0000 2016
"Ancillary Justice" Ann Leckie. 3 stars. Creative, but not striking, sci fi. Tue May 31 10:01:17 +0000 2016
"Fertility Without Fertilisers" Lawrence D Hills. 3 stars. Old school ideas on organic ag methods. Not much new for me except using comfrey. Sat Apr 23 09:40:49 +0000 2016
"Maskerade" Terry Pratchett. 3 stars. Sat Apr 23 09:36:04 +0000 2016
"Hero of Ages" @BrandSanderson. 3 stars. Felt stilted & cliched to start, but improved as Ruin's clever machinations were revealed. Wed Feb 03 10:20:10 +0000 2016
"Fight Like A Girl" Clementine Ford. 3 stars. Disturbing view from the trenches. Never thought of myself as an agent of the patriarchy!
"The Secret Chord" Geraldine Brooks. 3 stars. Great way to live some history.
"The Daylight Wars" Peter Brett. 3 stars. Unremarkable fantasy.

2.5 stars: 7 books (13%)
"Snow Crash" Neal Stephenson. 2.5 stars. Interesting vision of the cyber future but awkward mash of action, history and memetics. Tue Nov 29 08:00:35 +0000 2016
"Blood of Dragons"@robinhobb. 2.5 stars. Too many characters & dragons, not to mention teen love interests. Tue Nov 29 07:46:05 +0000 2016
"Banquet of Consequences" Satyajit Das. 2.5 stars. Debt & the GFC. Long-winded and contorted. Sat Nov 12 04:27:06 +0000 2016
"A Knight of the Seven Kingdoms" @GeorgeRRMartin_ 2.5 stars. Harmless but enjoyable. A few too many Aegons and Aemons ... Fri Sep 02 01:24:00 +0000 2016
"The Farthest Shore" Ursula Le Guin. 2.5 stars. Unremarkable fantasy doesn't match her others. Tue May 31 10:09:48 +0000 2016
"Fasting, Feasting" Anita Desai. 2.5 stars. Engaging portrait of Indian family life, but two distinct parts uncomfortably bolted together. Sat Apr 23 09:43:42 +0000 2016
"QF32" @RichardDeCrep. 2.5 stars. Biographical chapters were surprisingly more interesting than the overly-detailed accident itself. Wed Feb 03 10:22:05 +0000 2016

2 stars: 3 books (5%)
"Kraken" China Mieville. 2 stars. Disappointing - way too long and hard to follow all the jargon. Sat Nov 12 04:33:51 +0000 2016
"Gardens of the Moon" Stephen Erikson. 2 stars. Too many characters, not enough character. Sat Apr 23 09:55:33 +0000 2016
"The Tide Watchers" Lisa Chaplin. 2 stars. Historic novel set in Napoleonic France. A bit lame. Sat Apr 23 09:41:54 +0000 2016

1 star: 2 books (4%)
"Stranger in a Strange Land" Robert Heinlein. 1 star. Terribly aged, unbearably misogynistic. I had to stop. Tue Nov 29 08:02:18 +0000 2016
"Soil" Jamie Kornegay. 1 star. Lame thriller sucked me in with its irrelevant, tacked-on restorative ag theme. Tue Nov 29 07:55:14 +0000 2016

Wednesday, February 3, 2016

Best books 2010-2015

I've got 6 years of book reviews under my belt now.  I thought I'd pull out the 5 and 4.5 star books. 5 star books I consider to be brilliant and/or opened my eyes to a new way of thinking.  I would heartily recommend all the books below to anyone, no matter what their interests.  Actually, there are a couple of exceptions if you're not into ag/gardening ...

5 stars: 11 books
"The Rosie Project" Graeme Simsion. 5 stars. Hilarious. Brilliantly done. Engrossing.
"A Place Of My Own" Michael Pollan. 5 stars. Boy can he write! A stunning account of building and architecture.
"Infidel" Ayaan Hirsi Ali. 5 stars. Wow. Eye-opening. Shocking. More than a little worrying! Compulsory reading.
"Born to Run" by Christopher McDougall. 5 stars. Brilliant. Perfect mix of story telling and popular science. Will make you want to run ...
"The New Organic Grower" by Eliot Coleman. 5 stars. The ultimate guide to market gardening. Some new ideas. Makes me want to try!
"Meat: A Benign Extravagance" by Simon Fairlie. 5 stars. A brilliant examination of livestock and farming systems. For the ag nerd.
"The Omnivore's Dilemma" Michael Pollan
"Wild Swans" Jung Chang
"In Defense of Food" Michael Pollan
"This Accursed Land" by Lennard Bickel
"The Black Swan" Nassim Nicholas Taleb

4.5 stars: 22 books
"Island Home" Tim Winton. 4.5 stars. At last! Captures the strength of place that is Australia. Spoke to me strongly. Wonderfully written. Wed Feb 03 10:14:28 +0000 2016
"This Changes Everything" @NaomiAKlein. 4.5 stars. Unashamedly left-wing view on climate change, extractivism & democracy. Change is coming! Thu Dec 17 01:07:57 +0000 2015
"The Martian" Andy Weir" 4.5 stars. What a cracker of a story! Totally over-the-top and with some dubious bits, but heaps of fun. Sun Apr 26 00:40:42 +0000 2015
"Farmer Boy" Laura Ingalls Wilder. 4.5 stars. Such a warm immersion in the wholesome world of 19th century farming. A lot of work though! Mon Mar 02 08:50:21 +0000 2015 
"Blood & Guts" Sam Vincent. 4.5 stars. Ouch, @seashepherd counter-productive, Australia shallow and Japan patriotic. Great analysis & prose. Fri Jan 09 06:10:20 +0000 2015 
"Radical Homemakers" Shannon Hayes. 4.5 stars. A manifesto for living a home-based, non-consumptive life. Domesticity == revolutionary!
"On The Trail Of Genghis Khan" Tim Cope. 4.5 stars. Seemless and enthralling, historical, cultural and personal. A staggering achievement.
"Down To This" Shaugnessy Bishop-Stall. 4.5 stars. Hard-hitting, revealing, intense look inside homelessness. 

"The Secret Garden" Francis Burnett. 4.5 stars. The gentle awakening touch of nature, the Magic of life. Rang true and pulled the heart ...
"A Storm of Swords" George RR Martin. 4.5 stars. Blimey, he really hits his straps in this one. Great to be re-reading these.
"Mindsight" Daniel Siegel. 4.5 stars. Clear and rational explanation for how the brain/mind/emotions work. Very helpful & revealing.
"The Australian Moment" George Megalogenis. 4.5 stars. Politics and the economy as never been so interesting! Must read for recent Aus h ...
"The Antidote" Oliver Burkmann. 4.5 stars. A superb synthesis of pragmatic philosophies for how to live well. Must read! 

"The Wise Man's Fear" by Patrick Rothfuss. 4.5 stars. I wonder where it will go but don't care. Getting there is such a pleasure. 
"2001: A Space Odyssey" Arthur C. Clarke
"Harry Potter and the Goblet of Fire" J. K. Rowling
"Del Del" Victor Kelleher
"Hybrid: The History and Science of Plant Breeding" Noel Kingsbury 

"Cooper's Creek" Alan Moorehead
"The Explorers" Tim Flannery
"Animal, Vegetable, Miracle" Barbara Kingsolver
"Fooled by Randomness" Nassim Nicholas Tale

"1984" George Orwell
"Dirt: The Erosion of Civilizations" David R. Montgomery