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Domenico Gnoli, Two sleepers, 1966, private collection

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growing up, my mum always told me, whenever i went to the doctors or any sort of health professional, that it was important that i told them that i was hypermobile. she'd done the tests with me (herself being hypermobile and disabled in large part because of it) and though she didn't know the details, she knew that hypermobility was important to have in my health record.

so it was to my great surprise and displeasure that, whenever i told doctors i was hypermobile, it was skipped over. never addressed, never touched on, not even a comment to belie what that meant for me. i myself didn't know the impact hypermobility could have on a person, but my mother had been insistent about that fact. it was important, so why did no one else seem to think so?

i grew up with kids in school who were on the extreme ends of hypermobility. i knew a boy in middle school who could put both feet behind his head. i knew a girl in high school with long, spindly fingers who showed me how far backwards her arm could bend.

both of them had health problems, which became more profound as they aged. i never knew the details, but it stuck out that they were hypermobile, and so was i, and with my own health declining there HAD to be a connection.

common knowledge gives the vague definition of hypermobility as extra stretchy muscles, of being double-jointed. it comes with warnings not to push your hypermobile body into the extremes. don't overextend, you will hurt yourself.

the warnings are warranted. the importance isn't overplayed. these things i knew, but i didn't know why. and without knowing why, they were warnings that i could never truly obey, despite how conservative i became with my movements in a vain attempt to protect what little ability i had left.

hypermobility is NOT stretchy muscles. muscles are supposed to stretch. in fact, it's important to their health (those conservative movements prolly hurt more than helped!). hypermobility affects connectives tissues, and lands under the umbrella of Ehlers-Danlos Sydromes (there are a few) which can range in severity from affecting skin and tendons to affecting blood vessels and organs.

severity is rare, and much easier to catch. this post is for the people who are "a little hypermobile" so that they can understand what makes their body different.

a muscle and its associated tendons are like a hammock. the muscle is the fabric you lie in, stretching to accomodate the load. tendons are the rope that attaches the fabric to the trees, providing a secure anchor for the muscle to operate.

so, what happens when the ropes on the hammock are also stretchy? well, you sit in the hammock and your ass hits the ground.

now imagine that the fabric of the hammock has the ability to clench like a muscle. a normal hammock doesn't need to work that hard to stop ass from meeting ground, because it has sturdy anchors. a hammock with stretchy rope, however, must exert several times more effort, because the more the muscle pulls, the more the tendons stretch.

in short, hypermobility forces your muscles to work harder, because they must first pass the threshold of stretch the tendons are capable of before it can actually do the task it's meant to do. the stretchier the tendons, the harder the muscle needs to clench, the easier it is to overwork.

this info reframed everything i was doing with my body. small tasks of strength required the effort of much larger tasks, and larger tasks ranged from extremely difficult to impossible. holding my arms up so i could work above my head required monumental effort. with an anatomical peculiarity of the feet, i needed to use several muscles in my calves and hips just to stand without losing balance.

so no fucking wonder i crashed and burned in my 20s, when everything i did took all of my strength to accomplish. no wonder i would contort myself out of shape, so flexible that i could anchor myself into extreme poses just to give my muscles a moment of relief, overstretching myself without ever realizing why, and what damage i could be doing.

so, some things to remember:

overextending isn't good for you, but it shouldn't be your biggest concern. instead, be aware of overexertion, both how LONG you are using a muscle without breaks and how HARD you are using it.

small, frequent breaks are your best friend if you need to do something for awhile.

when you take breaks, stretch the muscles you'd been using.

if you need to exert effort to maintain a pose (whether it's sitting, standing, etc) examine whether you need to be clenching those muscles, and why.

actually whenever you are using muscles, try to train yourself to use as few as possible. you can practice by sitting or standing, and relaxing as many muscles as you can before you tip over. finding a sense of balance can make your life so much easier.

become acquainted with what relaxed muscles feel like. chronic tension can distort your perception of this, and result in habitual tension.

so yeah. if you're hypermobile, that's important. don't let a doctor's dismissal make you think otherwise. take care of yourself and know what you are and aren't capable of.

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I;m to hi

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Origami Miles Edgeworth. 2nd fold of the new color change version! Designed+folded by me, one uncut square of about 35 cm before folding. Red on one side and silvery on the other. This version is holding a crane! I used some of the would-be finger flaps to fold a crane for him to hold as I've been thinking about that one conversation since playing Trials and Tribulations.

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Now that Veilguard is out, this feels like he was trying to warn us.

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of all the ways to word this they managed to pick the worst one

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coffee makes you have to pee SO much i'm like maos wife over here

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Rest in Peace, Mr. Turner

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scientists are in labs right now creating the thinnest and worst material known to mankind so they can make women’s clothing

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the leaves are falling in the stream, the river flows away

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Snow leopards captured on trail cameras by Snow Leopard Trust

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Hi! This is kind of a weird question but how/why was influenza (and other diseases that we have vaccines for now) so deadly 100-200 years ago? Obviously vaccines help tremendously, and probably immunity over time, but are there other reasons that the flu was a much bigger deal a century ago? Sorry if this is oddly specific, but my current project is historical. Thank you!

This is a very interesting question and there are a couple of different ways of looking at it.

Let's start with influenza:

[Note: it's surprisingly difficult to get good worldwide flu data, so I'm going to use US numbers for the purposes of this post.]

I think the first thing to understand is that unlike many other infectious diseases, influenza is substantially different every year. That means that the immunity that you build in 2017 from either the flu or the flu shot won't necessarily help prevent you from getting the flu in 2023. By then it will be a different enough virus that your previous immunity won't be as helpful. Though it might make it a little milder. But keep reading, I'll give you some fun facts to share at parties:

We name flu (A) viruses based on two different proteins on the surface of the virus. The proteins are "H" and "N". There are 16 different "H" proteins, and 9 different "N" proteins that we currently know of. The combination of the two forms the "name" of a particular flu virus. Think H1N1, or H5N6, or any other combination. Each combination has their own attributes, which contributes to how infectious or deadly they are in any given year. And which ones circulate are different every year.

Just mathematically, that's a lot of substantially different flu viruses. Hundreds of them, in fact. And you have to build immunity to each one individually. You could, say, build immunity to H2N5, but that would do little to save you from next year's H4N3. And not only that, but within a single type there are many smaller variations. For example, say you got H5N3, but then it went and mutated. If you then got exposed again, you might have some immunity to new!H5N3, but it could also be just different enough that you still get sick.

Like I said above, different types of flu virus are deadlier or spread faster than others. H5N1 (a type of avian flu with a human mortality rate of 52%) is terrifyingly deadly but fortunately doesn't spread particularly well, while H1N1 (the star of both the 1918 and 2009 flu seasons) spreads rapidly and kills primarily young adults (weird, since flu usually kills babies and old people).

This is why in 2009 we did the whole "close the schools vaccinate the teens hide the president" routine. Because if it was *that* H1N1 we were all about to be screwed in ways we had never experienced before. Fortunately it wasn't, but thank goodness we did it. Also if you got vaccine #2 in 2009, you are also protected against the 1918 strain of H1N1. You're gonna be a hit at parties with that one.

Now, if you look at only deaths (not the best measure, but one with some emotional punch), within the last decade alone we have years where 12,000 people died of flu in the US (2011-2012) and years where that number is as high as 61,000 (2017-2018). These numbers are similar throughout recent history (relative to population), but then you get years like 1968 (where 100,000 people died in the US) and 1957 (where 116,000 died), and then sometimes you get these wild whopping years like 1918 where 675,000 died (equivalent to 1,750,000 people dying in today's US population). These fluctuations have happened since Hippocrates was around, and probably long before that, and there's really nothing to suggest it's getting any milder in any statistically significant way.

Now, outside of these natural fluctuations, we do have some ways of driving down these numbers. We do have a vaccine. It is different every year, based on our prediction of what the most likely or dangerous types of flus will be this year. Fortunately, you do get to keep this immunity for some time, so you can look at the flu vaccine as a personal collection of different flu viruses you have immunity to- you can collect 2-3 different ones every year in one shot and you didn't even have to catch them!! Yay! Unfortunately, since we never reach herd immunity with the flu vaccine, and we can't perfectly predict and incorporate all the strains that will circulate in a given year, while you do get some protection, it's not ever perfect. But it *is* still worth it.

We also have other feats of modern medicine as backup to the flu vaccine. We have oxygen, antiviral drugs like tamiflu, immune modulating drugs, and technology like ventilators to help keep people alive in ways we would not be able to in previous generations. So that's also an advantage. Unfortunately, these don't always work either, and we are still at the whim of those yearly fluctuations in influenza virus deaths.

And really, if you ask any epidemiologist, covid is just a little trial run for the next Big One. Which is both extremely likely to be a flu virus and which we're statistically overdue for.

TL;DR: The flu isn't getting milder so much as it varies wildly in severity every year. The next major flu pandemic is probably going to be in our lifetimes, so start collecting your flu immunity now if you haven't yet. New collections drop every August and are available until April. Get em' while they're hot. This year's included a 2009-like strain of H1N1 and a delightful H3N2 number from Hong Kong.

As for All the Other Vaccine Preventable Illnesses:

*ahem*

Yes, it's vaccines. It's obviously vaccines. Its basically only vaccines. Anyone who has ever told you it's not vaccines is lying. No other major discovery of modern medicine has ever saved as many lives, prevented as many disabilities, and created as many opportunities for a life well lived as vaccines have. No antiviral drug, no antibiotic, no ventilator can even hold a candle to vaccines. The answer is f*cking vaccines*.

I hope I have made myself clear.

Enjoy this table:

*Yes I do have a masters degree in public health and am a registered nurse that interacts with the public regularly, how did you know?

-Ross @macgyvermedical