You know, Amazon, I wouldn’t actually be crowing about the fact that you’re shipping something “sooner than originally expected” when the new delivery estimate was 420 days after the original estimate—so much longer that you had to send yet another e-mail telling me to enter new credit card information because the old one had expired in the interim. I especially disliked the way that you dribbled out little notices over the last fourteen months telling me to wait just a little bit longer and giving a new completely made up delivery date. (The aforementioned credit card e-mail is the only reason I have any confidence that you might actually have something to ship this time. Of course, I could have canceled, but that’s really not the point here.)

Don’t get me wrong; I still like you, Amazon, but you’re no longer seem as awesome as you were a couple years ago. For the first I’m starting to wonder about your supply chain and ability to fulfill orders. The main reason I keep coming back to you is price, but a large part is also trust. When you say something is in stock and available, I believe it will ship and arrive on the dates you listed. Normally you’re pretty good, but this isn’t the first time this has happened. (Usually, it’s for limited run art books like this one.) If more of this happens, I might have to reassess my position.

Now, I just wonder how long I’ll have to wait for my PhotoQuai 2011 book to arrive. . . .

Commande n° 	[snipped]
Date d'expédition : 	16 novembre 2011
Destination : 	Natick, MA, United States
Date de livraison estimée : 	6 décembre 2011

Suivez votre colis
Date 			Heure 	Lieu	 	Détails de l'événement
22 novembre 2011 	18:04 	Croydon 	Scan de départ
22 novembre 2011 	15:44 	Croydon 	Colis reçu par le transporteur

Updated 12 December 2011 — Hey hey! Both books arrived today. Since the original post last Friday, I have since read that if you’re ordering something from Amazon.fr, Amazon.jp, etc., it’s a good idea to use the somewhat more expensive expedited shipping option. It seems that returned deliveries after selecting the normal shipping method is somewhat de rigueur, on account of the super-saver shipping company not being very good at what they do when it comes to shipping to the USA. (Despite having the book in my hands, the DHL Global Alliance tracker still says that it’s in Croydon. Ha!)

See, it was like this. Saturday night Lisa was out singing her big, wonderful heart out in the second of three holiday concerts. I stayed home, since some friends and I were going to take it in on Sunday before going to a post-concert dinner and Muppet movie viewing together with Lisa. So there I was sitting on the sofa (with the cat sleeping on my lap) catching up on a week’s worth of snail mail, writing odds-and-ends and worry and bullshit in my journal, plotting out my 12-mile running route for Sunday morning, and watching TiVo’ed “BBC World News” and “Charlie Rose” episodes.

I go back-and-forth between liking and loathing Charlie’s show.

Shoulder Jeff #1: “He’s the voice of the American, white, male, moneyed, center-right Washington/NYC-based establishment. While his guests have a variety of opinions, they helped talk you into supporting the 2003 invasion of Iraq . . . or, at least, not opposing it.”

Shoulder Jeff #2: “True, true. But his guests also talk about all of those things that interest you. And since you don’t read as much as non-diabetes/triathlon stuff as you used to, he’s bringing those opinion-makers opinions to you. Besides, you only seem to write in your journal when you’ve been reading the New York Times, watching Charlie, or traveling. Clearly you need him and his guests for inspiration. Plus, you still have Terri Gross’s daily NPR show/podcast/tumblr Fresh Air for balance. Anyway, it’s good background noise while Lisa is away.”

Shoulder Jeff #1: “Okay, well at least be careful. Especially of his guests with ties.”

All true, little shoulder Jeffs.

The last episode I watched had three 40-to-60-something guys (all wearing neckties . . . except maybe John Meacham) sitting around his table talking about the GOP presidential clown parade candidates. It was not a great interview, but it made me want to read their little book: Playbook 2012: The Right Fights Back. It’s one of those “insiders traveling with the candidates tell you about the presidential sausage being made” works that I always like reading in Newsweek after the election.

Except this wasn’t a real book at all. It was one of those “electronic” books. Did I really want to buy a bunch of bits to read on my iPod?

Shoulder Jeff #1: “Why don’t you start, Jeff’s reactionary psyche voice?”

Shoulder Jeff #2: “Oh goody! Okay, I have a list. You won’t actually own anything. What if the forces enabling DRM decide one day that you aren’t licensed to read it anymore? And you won’t be able to lend it out after you’ve read it. And when you’re done where will it go? There’s no bookshelf-able “thing.” If your hard drive crashes, it will be gone. (Well, okay, not gone gone . . . gone-until-you-redownload it gone.) And *gasp* it will be hard to read page after page on a smaller-than-a-notecard sized thing. Plus you’re going to encourage the publishers not to sell real books anymore.”

Shoulder Jeff #1: “WTF, man? It’s not like the words are going to be different. And do you really want to keep this 73-page gem around for your never-to-exist grandchildren to pick up randomly off the bookshelf. ‘Oh look, that Michelle Bachman person sounded cray cray forty years ago.’ Riiiight. Or maybe you’re ‘going to need it for part of a major research project’ in the future? Yeah, okay. Listen. You’ve been buying virtual iTunes music for the last seven years, *and* you still buy CDs when you come across amazing whole albums. Plus it’s just $2.99.”

So I bought the e-book.

(That last paragraph was actually supposed to be the majority of this dispatch, but I got carried away. Sorry.)

• This morning I fired up Photoshop and made my design for Int’l DiabeTees Day. I like it a lot, but you’re just going to have to wait until Monday to see it.
• I’ve been reading a lot recently. A lot for me, that is. I don’t read quickly or as much as I would like, and I’m falling quite behind on my reading list. Earlier in the week I finished The Girl with the Dragon Tattoo, a gift from last year which I started reading in France. It’s okay. A bit long because of so damn many unneeded details, but ultimately an interesting read.
• Now I’ve returned to a novel that I started reading mid-summer last year: Colson Whitehead’s Sag Harbor. It’s not quite the page-turner that Apex Hides the Hurt was, but I do like it. It’s nice to see that in Whitehead’s mind, African-Americans are just as neurotic as white folk. I’m not 100% sure where we’ll end up at the end of this coming of age tale, but I should find out soon.
• Lisa and I have seen a new film each of the last three weekends: “Moneyball,” “Ides of March,” and “J. Edgar,” which we saw this afternoon. Of the three, “Moneyball” is the one with the most heart and the most interesting story. That’s kinda, I dunno, wrong if you ask me. Really, though, we’re just killing time until “Tinker Tailor Soldier Spy” is released in the US.

There’s really not much else going on.

Update—21 Nov. 2011: Lisa reminded me that we actually saw “Tower Heist” (which was lots of fun if you don’t expect too much) between “Ides of March” and “J. Edgar.” So, after adding in “Martha Marcy May Marlene,” we’ve seen five films in the last month.

Except that I don’t want perfect. I just want better. Better than where I have been. Better than where I am now. [1]

And where am I now? I exercise/train a lot, but I start out with higher blood glucose levels than I would like—sometimes very high—and I tend to drop a bit more than I’d like, too. (For a while that was about the only predictable thing about exercise.) During a couple of races it brought me to a walk, sucking up major time. I haven’t been able to figure out how much insulin (if any) to give when I eat during multi-hour bike rides. And then, of course, I have really good days, too.

I don’t expect perfection. I’d settle for predictability, though I’d really like something closer to “normal” BGs for two main reasons: Better BGs mean better performance, and higher BGs mean a greater risk of long-term complications. I know I have a disease, but I also know that I’ve had great experiences with it. I want more of those. Figuring out how to do that will keep me safer, healthier, and happier.

So I finally got around to reading a book that’s been on my shelf for about 18 months: the second edition of The Diabetic Athlete’s Handbook by Sheri Colberg. (I’d started it multiple times, but I’m a champ at getting distracted.) It’s a shame that it took me so long, because it’s full of great information.

The book has two parts. The first provides some general background on the physiology of exercise—how our bodies use energy—along with how diabetes alters this and the main ways that we can work it. The latter chapters of the book give some recommendations for specific athletic activities: from cycling to kickboxing and everything else.

I found the physiology parts really interesting. [2] The body is a mysterious thing, and I like learning how to make it work well. Here’s a bit of useful information from the book:

• There are three energy systems that get used by muscles. The shortest duration system only lasts about ten seconds. The lactic acid system can go for a minute or so. Then there’s the aerobic system that powers endurance activity and can last for hours.
• Consequently, the intensity and duration of activity impact what energy sources your body uses: muscle glycogen, blood sugar, glycogen stored in the liver, fat, etc. Knowing what kind you’re going to use can help you plan how to approach an activity.
• There’s a hormonal response to intense activity—such as sprinting or hill climbing or power-lifting—that reduces the effect of insulin. This can make blood sugar go up and (paradoxically) suggests that brief, four-second bouts of sprinting can help keep BGs from dipping as much during endurance events.
• People with diabetes have almost exactly the same physiological response to exercise and competition as people with functioning beta cells except that we add our own insulin. The rest is quite similar: the amount of calories burned for the same duration and intensity, how long it takes food to hit our blood stream and muscles, the effects of adrenaline and other stress hormones, etc. We (mostly) need the same amount and kind of food to fuel our activities; we have the same hydration needs; we have to prevent the same injuries; and we can benefit from the same mental preparation.
• The lack of our own insulin production (for Type 1 folks) and insulin resistance (for Type 2s) are the tricky bits. (Duh! Those are defining characteristics of diabetes.) There’s an optimal plasma insulin level—usually lower than normal for aerobic activity— that stimulates glucose production in the liver and that enables muscle uptake. Too little insulin, and the liver continues to produce glucose but the muscles can’t take it. (BGs go up a lot.) Too much insulin, and the liver reduces its contribution while the muscles soak up lots of the available blood glucose. (BGs go down a lot.) If you can find the (ahem) sweet spot, BGs should stay pretty stable and cause the body to use the energy source(s) as in a person without diabetes.
• Exercising in the morning is frequently easier for most people because of the lack of recently bolused insulin and because of all those happy wake-up (stress) hormones.
• Aerobic (endurance) activities make insulin more potent, both during exercise and for 12-48 hours afterward, as it moves glucose out of your bloodstream to replenish your muscle glycogen stores.
• Hypoglycemia begets more hypoglycemia. If you’ve been low in the last 24 hours or so, the stress hormones that would help prevent it during exercise are inhibited. Your chances are much higher that you’ll be hypoglycemic again.
• Evidently, having girlie parts also makes a difference with diabetes and exercise.

There’s so much information in the book—including some charts that might help you determine how much to change your insulin dosages before exercise and events—that it’s really worth getting your own copy and going through the first 125-or-so pages.

I’m going to sum up the remaining 140-ish pages, which are also very useful, this way: Whatever Works. Colberg divides more than 60 different sports and activities into five general categories, gives some guidelines about how to approach them diabetes-wise, and then provides a bunch of information from different athletes about what works for them.

That last part of each section was the most instructive aspect of the book for me. Technically, it didn’t teach me much new, but it let me know that there’s no best way—much less one right way—to approach exercise and sport with diabetes. In one paragraph an athlete describes what works for him or her, while the next shows someone doing something that seems almost 180-degrees opposite. There may be a half-dozen “right ways” to exercise or compete in an event with diabetes. Not only may your diabetes vary from mine, but it might be possible for the same person to get to the same outcome (more or less) consistently using different techniques.

Whatever works. The key then becomes finding what works for you. This book can help get you there by understanding what your body is likely to do for different activities and then providing you some suggested starting points and anecdotes about what has worked for others.

From there it’s all trial and error . . . and note-taking. But that’s something to take on next time.

1 — And by “now,” of course, I mean a couple weeks ago when I started writing this post. [Back . . .]

2 — Full disclosure: The year-long course in anatomy and physiology was my favorite high school class. [Back . . .]

Reid’s journey around the world in search of ideas that the United States can borrow in order to make substantive improvements in healthcare is shaping up to be a good read, and I will post some ideas from it. I’ll get the ball rolling by noting the four axes he’s using to gauge other countries’ health systems:

• Coverage — How many people does the system cover? Who makes access-to-treatment decisions? Everyone else’s systems seem fairer than the US model.
• Quality — How can the United State match health outcomes of other countries? People in most other rich nations have better health than we do.
• Cost — How much do those other systems cost? How do other nations spend less per capita than the US?
• Choice — What are the options and trade-offs for seeing the doctors you want at the hospital you want in a timely manner?

I may ask you, my dear readers, about some of these issues. Stay tuned!

“But, Jeff, there’s nothing to do at work in the days leading up to American Thanksgiving. Entertain me!” Oh, okay. Here are some wonderful, fun sites I discovered recently:

• Bookshelf Porn
• Forgotten Bookmarks
• Secrets of Paris
• The Oatmeal

Enjoy your pre-Thanksgiving TSA pat-down.

Soon! I’ve set it aside for far too long. The book helped me decide that it’s time to get back to it. It’s possible that the act of publishing will actually help me figure out how I want to finish up the project.

Self-portrait, North Brookfield, Mass. (2006)

Last night after looking at our Australia book and thinking about what I would put in a new book, I decided that I need to dust off my old slides that relate to the project. I had forgotten how much I love some of them. After a hard drive crash in 2006 that ate up most of my old scans, I need to rescan a bunch of photographs before I can publish them. The good news is that I now know a lot more about post-processing than I used to, and I’m determined to do a better job than I did the first time around.

Step One: Tonight I calibrated my PC monitor for the first time in years, fixed a few flaws in my scanning workflow, and created a new scanner profile. Early results indicate that it might be easier to get what I want this time around.

Making the scanner profile

Stay tuned!

What’s that? You want something more nuanced? You want to know how it compares to fine art books and prints? You want me to critically evaluate the Blurb book itself? Okay, but just remember that it was (a) my first book from Blurb, (b) something that we did in an afternoon, and (c) something I could probably do better on my second go. Oh yeah, and I’m a fastidious perfectionist.

First off, let’s just get this one thing out of the way: The book is not equal in quality to a fine art photography book printed by Aperture, Steidl, Phaidon, etc. Those books appear to have finer resolution, better color, and higher production requirements. Then again they’re printed in much larger runs with lots of proofing all along the way. Okay, now that the obvious is out of the way, what did I really like?

• The cover looks beautiful. I think it’s slightly higher quality than the inside pages.
• The colors are quite good, even for a non-color-managed workflow. I know better than to compare the colors of the print to my monitor, but the colors match my memory and the gamut is decent. (They explicitly say they aren’t using an ICC workflow but seem to expect sRGB input.)
• The paper is nice. We used the slightly more expensive “premium lustre” paper.
• The binding is quite good.

What’s on the other side of the ledger?

• The halftone pattern is occasionally rather obvious, especially in continuous tone areas (such as the sky or clothing).
• Some of the skies look a bit splotchy. (It’s subtle, but still . . .) I can’t tell if some noise is getting sharpened or if there are compression artifacts during upload. Perhaps it’s something else.

Next time around — and there will be a next time, I’m sure — I’m going to pay more attention to my output sharpening, image dimensions, and compression settings. (It’s testament to the quality of Blurb that you can get a good quality book on the first try without using any of the information in the support forum.)

It’s definitely a good value. And I love our book.

Yesterday — both before and after we went to the opening — Lisa and I created a photo book that’s about to be printed via Blurb. If you discount the A-B-C’s book I wrote and illustrated in kindergarten, it’s the first book I’ve made. I print a fair bit, enjoy typography, and love photo books.* Despite loving photo books, this will be my first.

Lisa and I took some of our favorite photographs from our trip to Australia and built a book using Blurb’s BookSmart tool. It was pretty easy and very customizable — albeit a bit clunky if you want to make a lot of edits — and a lot less “cute” than what Snapfish offered. (You can even use Adobe InDesign or another tool, if you want.) I’m certainly hoping that the photos in the book look great . . . at least as good as mass-market photography monographs. If they do, I’ll probably make one containing some of my “arty” photographs.

* — I could easily amass tens of thousands of dollars of credit card debt buying photography monographs and exhibition catalogs. So it’s best that I don’t look too much at Amazon, otherwise my photography wish list would probably include the whole art and photography section.

For me it was also a history of what I avoided by being diagnosed with type 1 diabetes after 1922. Bliss includes a small sample of the lives of some of the people afflicted with diabetes before the discovery of insulin. I was truly inspired by those who were fortunate enough to receive this “miracle drug,” but I was heartbroken by all of the people of that age who didn’t make it because the only treatment was to survive on a meager 500-or-so calories for intolerable months until slipping into the coma of ketoacidosis and then (eventually) death.

It’s been almost 89 years since the first successful clinical use of insulin, but we still don’t have a cure. At best, insulin is the key part of a hormone replacement therapy where people with diabetes try to mimic a pancreas. At worst, insulin is a fickle treatment that is difficult to use, expensive, and out of reach of millions of people worldwide.

While I’m so grateful for what I have — a treatment that gives life — what we need now is a cure . . . even if it’s only useful for people who are not yet sick or are newly diagnosed.

If you’re working on a cure or a new therapy for diabetes, the rest of this post is for you.

I will help you with any technical software aspects of your research that you need. If you have questions about MATLAB or C++, I will do my very best to answer them. If you need help with software design or object-oriented analysis/design, I can help you structure your solution. If you require some help with the non-development aspects of software development — such as project management or using tools — I will help you there, too.

My particular areas of expertise are MATLAB, C++, medical imaging formats (such as DICOM), some familiarity with image processing, and multithreaded programming using Intel’s TBB. I also know my fair share about life with diabetes. I can’t promise that I’ll have all of the answers to your particular question, but I’ll work with you as much as I can. And I’ll connect you with my coworkers as much as I can, if it comes down to that. Finding a cure that’s safe, effective, and universally accessible isn’t my day job, but moving into the third era of diabetes where no one dies from it and no one has to impersonate a pancreas is something I’d love to be a small (even anonymous) part of.

You can e-mail me at work or home, and you can hit me up on Twitter, too.