180

 

 

My weight has gone up and down most of my life. I was a chubby kid, a skinny teenager, and I put weight on and off throughout my adult life. About a year before Andrew was born, I stepped on a scale at a clinic where I was volunteering and was not able to get my weight. The scale would only weigh up to 300 pounds. My body mass index (BMI) was 39 kg/m². My waist size was more than 40 inches, which meant that I was at very high risk for cardiovascular disease and type II diabetes. In 2014, I had a physical exam before going to Sierra Leone. I weighed 284 lbs. I’d lost around 20 lbs. and felt pretty good about that. Nevertheless, my fasting blood glucose was still over 100 mg/dL, which meant I had prediabetes.

 

Although she's no longer "in the business," Holly, my wife, is a professional photographer and knows how to make people look good. I went to Africa twice in 2014 and was bothered when I saw photographs of myself taken by other people. I didn't realize how bad I looked. I was 52 years old and had a two-year-old son. I realized that, if I wanted to see Andrew reach adulthood, I needed to get my weight under control.

 

Haydom, Tanzania 2014

I had been riding a bicycle for many years. I was riding 100 miles per week when Holly and I lived in New Orleans, but New Orleans is flat. The biggest "hills" I had to climb were the levee and I-10 overpasses. When we moved back to the Pacific Northwest I had get used to not only hills, but cold, wet winter weather. That took a couple of years.

 

I started pushing myself; riding more miles, riding up hills that I had previously avoided, and riding in miserable weather. I also changed my diet, although not drastically. I cut down on carbohydrates and ate more salads. I bought a rowing machine so that I could keep up my workouts during the winter months when it was too cold or wet to ride. I started keeping track of my weight and used an app on my cell phone to track my rides.

 

I took some long rides in the summer. In July 2016, I took a couple of days to ride the Olympic Discovery Trail from Port Townsend to La Push, Washington. In June of this year I rode from Tacoma, through Seattle to the Snohomish County line, around Lake Sammamish, then through Renton, Black Diamond, Enumclaw, Buckley, Puyallup, and back to Tacoma. To celebrate my 55^th birthday, I rode from Tacoma to the coast and back.

 

June 2017

 

July 2017

 

In September 2015, my BMI dropped below 30 kg/m² - overweight, but no longer obese. A year later my BMI was less than 25: normal weight. This September the scale dipped below 180 lbs (BMI 23.1). My total cholesterol and triglycerides dropped, my high-density lipoprotein (HDL; "good" cholesterol) is up, and my fasting blood sugar is below 100 mg/dL.

 

 

 

I rode through last winter, but that put a lot of wear and tear on my bicycle. Now that I've achieved my weight loss goal, I've decided to start working on strength training this winter. I picked up a set of weights and read a book titled "Weight training for cyclists."

 

This hasn't been easy. It's been a huge commitment of time. So far this year I've spent 478 hours riding my bicycle, which doesn't include most of my rides to and from work. It's also been expensive. I bought a new bicycle last year and have had to replace a lot of parts and buy tools so that I can work on my bicycle instead of paying someone else to do it. I've also had to buy new clothes. The clothes I bought last year are too big for me now.

Replacing brake pads

 

I could not have done this without Holly's help. She has graciously allowed me to take the time I need to ride as much as I have. In return, she gets a healthier husband and Andrew gets a daddy who can keep up with him!

 

 

One final note: I've put my background in neuroscience nursing, public health, and bicycling to use as a member of the Cooper Jones bicyclist safety advisory council. One of our objectives is to encourage more people in Washington State to ride bicycles by making cycling safer. You can read more about it on the Washington Bikes website.

Andrew with his uncle Seth. I met Holly while I was taking care of Seth who had a traumatic brain injury in a motor vehicle accident.

 

 

 

 

 

 

 

Mumps

I’ve intended to write about mumps for nearly a year. Parenting and bicycle riding have taken my time and attention away from this blog. More about that later.

 

It was about this time last year that our mumps epidemic started. Over a four month period we had 59 confirmed and probable mumps cases. We investigated an additional 118 suspect cases and 52 people who did not meet one of those three classifications and were ruled out for mumps. That and a bad influenza season kept my colleagues and me busy! Other jurisdictions had far more cases than we did. King and Spokane counties in Washington State each had more than 300 confirmed and probable cases. Arkansas had nearly 3,000 cases.

 

Mumps is a viral disease characterized by swelling of the parotid salivary glands, which are on the side of the face in front of the ear. One or both parotid glands may be swollen and sometimes other salivary glands are swollen. The parotid gland may become so large that the swelling covers jawline extends to the neck.

 



CDC

 



CDC

The photographs above are from the Center for Disease Control and Prevention (CDC) Public Health Image Library. The first shows "characteristic swollen neck region." This is the photograph that is on the CDC's mumps webpage. The caption of the second photograph reads, "cervical [neck] swelling due to enlargement of the submaxillary salivary glands." What is not clear in either of these photographs is swelling of the salivary glands on the side of the face. The submaxillary glands are under the jaw and can be swollen with mumps, but it's rare that swelling of other salivary glands occurs without swelling of the parotid glands. Neck swelling can be caused by inflamed lymph nodes (lymphadenopathy), so not everything that looks like mumps is mumps.

 

Other symptoms of mumps include orchitis (painful swelling of the testicles), oophoritis (painful swelling of the ovaries), meningitis, and encephalitis. In fact, before the vaccine was developed, mumps virus was the most common cause of encephalitis in the United States. Permanent deafness in one ear is an uncommon complication of mumps. About one third of people infected with mumps virus have no symptoms but can still transmit it to others.

 

Parotitis can be caused by other things, including bacteria and other viruses. When mumps virus is not circulating in a community, sporadic cases of parotitis are likely to be caused by a virus other than mumps. There are also non-infectious causes of parotitis. Again, not everything that looks like mumps is mumps.

 

Mumps is the second M in MMR: measles, mumps, and rubella vaccine. Mumps outbreaks are uncommon in the U.S. because most states require children to have two doses of MMR by the time they start kindergarten. A few states require only measles vaccine or measles and rubella vaccine but, because MMR and MMRV (varicella: chickenpox) are the only measles-containing vaccines licensed in the U.S., most children in this country have received two doses of mumps vaccine by the time they start kindergarten.

 

So, why do we have mumps outbreaks in the U.S.? As I wrote before, no vaccine is 100% effective. A single dose of mumps vaccine is around 78% effective at preventing mumps. Two doses is about 88% effective. There is also evidence that immunity from mumps vaccine wanes over time. Outbreaks usually occur in places where people live in close contact with each other like military barracks or college dorms. Mumps is transmitted by respiratory droplets, contact with people infected with the virus, and contact with objects that are contaminated with the virus (fomites).

 

Respiratory droplets (CDC/ Brian Judd)

I can’t say how effective MMR was at preventing mumps in Pierce County. As I wrote in my post on attack ratios, I need the denominators: the number of vaccinated people exposed to the virus and the number of unvaccinated people exposed to the virus. I also don’t have the numerators. Immunization records are available for most children in Pierce County but frequently not available for adults. What I can say is that very few cases of mumps could be attributed to transmission in schools in Pierce County. Most of our cases were linked to another person with mumps living in the same house or transmission in a setting other than a school in Pierce County, e.g., workplaces or schools in the Auburn School District where there was a large outbreak.

 

“MMR is banned in Japan!”

 

Not exactly.

 

A different mumps virus was included in the Japanese MMR. The Urabe AM9 mumps vaccine was associated with higher incidence of viral meningitis. Although viral meningitis is usually self-limiting and does not result in longterm problems, Japan now uses a measles and rubella (MR) combination vaccine without a mumps component. No increased risk of viral meningitis has been found with the Jeryl Lynn strain, the virus used in the MMR and MMRV vaccines license in the U.S. Incidentally, both viruses are named after the children from whom the viruses were taken. Jeryl Lynn is the daughter of Dr. Maurice Hilleman, who developed over 40 vaccines, including mumps.

 

Andrew started kindergarten this year.

 

 

 

 

 

More information:

 

CDC: Mumps cases and outbreaks

 

References:

 

Barskey, A. E., Juieng, P., Whitaker, B. L., Erdman, D. D., Oberste, M. S., Chern, S. W. et al. (2013). Viruses detected among sporadic cases of parotitis, United States, 2009-2011. Journal of Infectious Diseases, 208(12), doi:10.1093/infdis/jit408.

 

Campbell, J. R. (2014) Parotitis. In J. D. Cherry, G. J. Harrison, & S. L. Kaplan (Eds.) Feigin and Cherry’s textbook of pediatric infectious diseases, 7^th Ed. [Electronic version]: Saunders.

 

Davidkin, I., Jokinen, S., Paananen, A., & Peltola, H. (2005). Etiology of mumps-like illnesses in children and adolescents vaccinated for measles, mumps, and rubella. Journal of Infectious Diseases, 191(5), doi:10.1086/427338.

 

Hatchette, T. F,. Mahony, J. B., Chong, S., & LeBlanc, J. J. (2009). Difficulty with mumps diagnosis: What is the contribution of mumps mimickers? Journal of Clinical Virology, 46(4), doi:10.1016/j.jcv.2009.09.024.

 

Litman, N. & Baum, S. G. (2015). Mumps virus. In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds). Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8^th Ed. [Electronic version]. Saunders.

 

Parker Fiebelkorn, A., Barskey, A., Hickman, C,. & Bellini, W. (2012). Mumps. In S. W. Roush & L. M Baldy (Eds.) Manual for the surveillance of vaccine-preventable diseases, 5^th Ed. [Electronic version]. Center for Disease Control and Prevention.

 

Rubin, S. A. & Plotkin, S. A. (2018). Mumps vaccine. In S. A. Plotkin, W. A. Orenstein, P. A. Offit., & K. M. Edwards (Eds.). Vaccines, 7^th Ed. [Electronic version] Elsevier.