As previously reported, I took the week of surgery off from work. This was a really good move: even though I was feeling a lot better than I'd expected (and my work basically involves reading words on a computer screen, typing, and occasionally talking to people), the dedication to resting and relaxing really helped my mind reset, my energy rebound, and focus on readjusting to food.
I spent the second week working from home, which was also a smart move. I was still on a liquids-and-purées diet which was made much easier by having a refrigerator and a fancy blender fifteen feet from my desk. My dad brought over a big ring of red Jello (a food with strong Stone family associations), Lucky's Market recently started carrying nice cashew yogurts, and I had several bunches of bananas with staged ripeness. I noticed that I pretty quickly transitioned back into "Wait, there's one more thing I should do" mode while working, but since I'd handed off a lot of responsibilities, the number of just-one-more-things was fairly low.
A week and a half after surgery I drove back down to the hospital for another x-ray barium swallow to see how thing were going down. After about two swallows of barium liquid the lab tech got a worried look on his face and called a doctor in to look at the images and compare them to what they saw the previous month. After conferring and calling my surgeon's office, they announced that the study was done and I could leave. Not particularly reassuring…
I had a "review the barium study" appointment scheduled with the surgeon two hours later, so I hit up the army surplus store between the hospital and his office. While trying on a pair of nice "tactical trousers" the hospital called and asked me to return (also not very reassuring…). My surgeon showed me the imagery sequence and pointed to a pattern of liquid spreading that looked like it could be a leak. He was suspicious of this interpretation, though, because I didn't show any signs (like total misery) of having been eating with a perforated esophagus, stomach, or junction for ten days. He had me lie down for a regular x-ray and then conferred with the folks from the barium swallow. After a few minutes he came over and said "What I thought was a leak and what they thought as a leak were two different parts of the image." The additional x-ray and mutual second opinions ruled out leaks in both cases. Thank goodness for questioning data and interpretation.
The recommended diet progression is soft food for the third and fourth weeks. I returned to work since I knew I could depend on tuna salad, egg salad, and hummus in the daily lunch salad/sandwich bar and soggy Cheerios (working up to granola) for breakfast. These were my work-food staples for the second half of last year, so I was confident I'd be able to handle them. I was also very excited to reintroduce things like moist grains (rice, barley, oats, and friends), noodles, berries, and tofu. In week four I made three peanut butter, tofu, and chocolate pies for our office's π Day celebration. The puréed legume goo was a little challenging for my swallowing skills, but not problematic. I was also able to eat several folks' apple pie filling and even some flaky crust. I was able to survive some corned beef, potatoes, mustard, and lamb stew on St. Patrick's Day, though I had a regurgitation episode and concluded that was a little too ambitious.
By the recommended diet progression, I should be more or less back to a normal diet. I'm still eating slower than a normal person, but I can now finish most or all of a large lunch in an hour, which is 80% faster than I could handle a medium plate four months ago. I can get through about 75% of a meal at a restaurant before taking home a box. Spices, dry fish, and little bits that slip through without chewing are still challenging and have led to a few regurgitation episodes, but I'm able to respond to most issues by just pausing a meal and walking around. I've been fairly shy about meat that hasn't been soaked in soup, but I was able to handle ground beef today. I think I'll wait at least another week for meat that I have to cut, but I'll be trying sausage in a day or two.
I've had several intense reflux bouts, usually about half way through the night, though yesterday featured an extended before-bed adventure with mild heartburn. Combinations of Altoids, crystalized ginger, and water only sometimes help settle symptoms. When planning surgery I was aware that a significant fraction of folks experience ongoing heartburn and acid reflux. Having spent 2015 dealing with painful reflux and 2016 dealing with regurgitation and weight loss, I'd decided that I'd gladly trade the latter for the former. I need to get better at building up sleep reserves, though, 'cause I can lose an hour to three of sleep from heartburn without advanced warning.
This month I switched projects at work (still under the umbrella of Drive). We're in the "Figure out what the heck our users really need" phase which means our engineering pace is fairly relaxed and we spend a lot of time reading and theorizing, which has been helpful in continuing my "avoid stress" plan. Unfortunately, I've easily fallen back into the habit of going to bed at 1am, so I'm not making many deposits in the sleep bank, despite not needing to take a lot of withdrawals.
I've still got a "eat as many calories as you can" mindset, but I thankfully don't have to micro-optimize my decisions around it. I'm finally back to having alternating phases of hunger and meals rather than a continuous stream of slow eating and reduced metabolism. I've got way more energy than I did during the second half of last year and I don't feel like I'm in survival mode. I was able to quickly get my weight back to the low 120s but haven't been able to make progress beyond that. I guess my normal metabolism—which has basically been at late-teenager levels for twenty years—has returned. I've abandoned my "eat a pint of ice cream for dessert" weight gain plan, since it seemed to be more effective at triggering heartburn than fat storage. Maybe I should try increasing my beer intake :-)
After scheduling it, I haven't had any second thoughts, bouts of dread, or even niggling worries.
Most of our office is playing musical chairs at the end of this coming week, when I'm out. So my last act of heavy object lifting for a while was packing my desk on Friday. This should help me unplug from work while I'm at home recovering: there is no longer an ethernet cable connected to my computer, so I couldn't SSH in and hack on something if I wanted to. (Email, of course, is a much more sinister temptation.)
I spent most of this week fighting a cold, which helped put me in "Hang around the house not expending much energy" mode but didn't help in the "fatten up before surgery" department. The cold reduced my appetite and severely depressed my appetite for sugar. Not wanting sugar sounds like it would be a good thing, but I had to spend this weekend on a clear liquid diet, so I'd been planning to get most of my calories from sweets.
My mom got me a jar of unflavored gelatin for Christmas (before she knew I was having surgery). Gatorade powder, gelatin, and water turns out to be a pretty tasty way to get some calories, protein, and electrolytes. And if you halve the recommended gelatin to water ratio it's pretty easy to drink. I should try this combo at Burning Man.
I had my last meal, of sorts, at Sushi Zanmai on Friday night. I wasn't especially hungry (because of the cold), but ate a bunch because it was so tasty. Rice and fish are some of the first items in the solid portion of the recommended recovery diet progression, so maybe I'll be able to return before too long. I had a hamburger at lunch and probably won't be able to do so again until the end of March. Maybe it'll be my half-birthday treat.
Part of my plan for recovery time was to read The Conscience of a Conservative so I'll be better prepared to have conversations with Republican lawmakers and potential issue allies on the conservative side of the spectrum. My plan for Saturday was to visit used bookstores until I found a copy. After five bookstores and $120 I didn't have any Barry Goldwater, but I did end up with a copy of A People's History of the United States. I also overheard a Bookworm employee tell a customer that they were sold out of 1984. I didn't end up without materials to strengthen my transpartisan dialog skills, though: Don't Think of an Elephant!, I'm Right and You're an Idiot, and The Righteous Mind are now in my possession. I still intend to read TCoaC, but now my plan is to borrow a copy from the public library, which seems like an especially apt approach to that book.
Most importantly: I don't have to eat every dish you bring! Feel free to make something delicious even if I won't be able to have it. There will be enough food on the table that I can eat.
Executive summary: texture and thickness are key; spices are limited; strong acids are suspect; fats, sugars, and salts are fine. The simple version is "No dairy, no eggs, no to most spices; either very soft or very crunchy."
The details follow. I realize this is long; feel free to send me a recipe and let me call out anything that will cause me trouble.
The most probable explanation for my eating challenges is that the sphincter at the bottom of my esophagus has trouble opening. This manifests in food restrictions based more on consistency and texture than on ingredients. For instance, I can drink a smoothie with blended peanuts, wheat germ, and barley malt but I have trouble with peanut butter on bread.
The texture spectrum:
- SAFE: Foods that can be sucked through a straw (broth, smoothies…)
- SAFE: Foods that dissolve in your mouth or otherwise can be eaten without teeth (ice cream, banana, pumpkin puree, mashed potatoes, hummus, halva…)
- SAFE: Soft blocks of protein (lunch meat, ham, tofu…)
- SAFE: Firm foods that chew into small pieces (nuts, carrots, some chips and crackers…)
- PRETTY SAFE: Foods softened in water (boiled or canned vegetables, noodles, cooked legumes, cooked grains…)
- POTENTIALLY DANGEROUS: Soft but sticky foods (bready substances, nut butter, french fries, lettuce…)
- DANGEROUS: Foods with gristle or fibrous bits that are difficult to fully masticate (steak, ground beef, kale, spaghetti squash, many fresh vegetables…)
Additionally, there are some ingredients which my body has painfully rejected in the past few months and I now avoid. Aside from dairy, most of these are foods I've loved eating regularly over the last twenty years, so I really hope I can eat them again by next Thanksgiving.
- Dairy (milk, cheese, cream, butter… anything derived from a mammal's udders)
- Eggs (this prohibition adds a lot of challenge to my diet)
- Extra-virgin olive oil
- Red wine
- Capsicum peppers (both spicy and bell)
- Peppercorn/black pepper (basically anything with the word "pepper" in it)
Since several spices have led me to have absolutely miserable days, I'm taking a very cautious approach to spice. I'm able to handle cinnamon, cumin, ginger, and garlic. If a product lists "spices" as an ingredient, I don't eat it. For individual herbs and spices not explicitly listed I decide on a case-by-case basis. If there's a spice you'd really like to bring to Thanksgiving (particularly in the savory category), let me know and I can do a trial in advance–I'd love to collect some more data.
I'm also taking a cautious approach to highly acidic foods like tomatoes, many fresh fruits, and alcohol. I might accept these if offered or I might decline.
Fat, sugar, and salt are all good. I'm currently dramatically underweight, so the standard dietary advice given to Americans doesn't apply to me–I'm finishing a whole pint of non-dairy ice cream as I write this and I eat plenty of bacon. I can eat plenty of fat as long as it doesn't make food stick to the throat like salad with dressing (and as long as it's not butter). High sugar is fine too; my morning smoothies feature honey, molasses, or syrup. My dietitian also recommended I have 50% more sodium than the max recommended level, so salt is fine. (I'm currently trying to keep dietary fiber low, but I don't worry much about fiber content at social events, so don't sweat it.)
Common food restrictions:
Other than dairy and eggs, I seem to be okay with all the common allergens (nuts, legumes, gluten, soy, shellfish…). I don't follow any preparation-based restrictions (kosher, halal, raw, fair trade…). For the most part, if I can easily swallow it then I want its calories in my belly.
I know you mean well, but whatever diet or food you've heard is good for something or other is probably not applicable to me. Most diets have weight loss as a goal, but losing more weight would significantly compromise my health. It's hard to sell diet books if weight gain is a side effect, so if you've heard of a diet, it's probably not right for me (unless you've got a good recipe for chanko nabe). Similarly, I'm actually trying to avoid anti-inflammatory foods for a while. When I was diagnosed with an autoimmune disorder I went full haul on anti-inflammatories. Unfortunately, I think the COX-blocking effects may have negatively impacted my gut, so I cut them out of my diet (with the exception of omega-3 fatty acids and ginger). If you saw an article about some wonder food or supplement, I'm probably avoiding it.
The hawthorn trees produced a nice crop of berries that I've frozen with plans of a haw-mead. The pear tree produced a measly five or six pears, almost all on the branch leaning on the side of the house; perhaps it got enervated by the wacky late spring snows. I was looking forward to making something with the Oregon grapes in the front yard, but deer beat me to them. Four rhubarb plants were on overdrive, producing fodder for a couple pies, some stand-alone compote, and two gallons of chopped stalks for future use.
Of the crops we planted, tomatoes, chili peppers, and some tiny orange hot peppers did well. Our attempts at genus allium (onions, leeks, and maybe some shallots) did almost nothing. We got a few jalapeños, four small eggplants and two mystery gourdlike squashes, one of which the squirrels devoured. The tomatoes, peppers, and mint went into some excellent salsas. I'm mulling over plans for the chili peppers, maybe I'll use them for our office's annual chili contest.
Combining plants with microorganisms, I made two beers this year: a Belgian wit and a ginger juniper saison. The former involved a few mistakes, including turning down the heat when it boiled over and then forgetting to turn it back up. This led to a remarkably smooth beer without strong hop bitterness; several people who don't normally enjoy beer have expressed delight at it. The latter also came out quite well; despite my kitchen tendency to turn flavors up to eleven, the ginger isn't overpowering and the juniper is subtle. I used fresh juniper berries from the backyard tree and their flavor from the initial boil was basically undetectable. Just before bottling I added water boiled with juniper berries and mint leaves to just the right taste and aroma. The mint quickly disappeared, though.
The nice thing about homebrew and gardneing as hobbies is that non-human biological agents do most of the work. A weekend here and there of cleaning, cooking, and weeding lets the real work of converting sunlight to chlorophil and sugar to alcohol to entities which don't have to go to the office five days a week.
I don't remember if it was my N.D. or the book she gives to new patients who said it, but the biggest insight I've ever heard about diet is "It's essentially impossible to lose weight while you're eating something you're allergic to."
I've learned that food and mood are connected in a way that's far less intuitive to us than food and physical sickness. If we eat a bunch of clams and then throw up the next day, we blame the clams. But if we eat a bunch of bread and then feel mopey the next day, we don't instinctively blame the bread.
When I stopped eating dairy products 20 years ago, I had an immediate (well, over a month) improvement in both mood and focus. I wasn't anything resembling bipolar, but I would often get pretty depressed about things. I attempted suicide by dehydration (a method which allows one to back out at any time). I frequently stayed home from school because I was just feeling "bleh." If one detail of a homework assignment didn't make sense, I might end up lying on the floor for hours crying about it. I'd start all sorts of passive aggressive fights with my brother.
Once milk was out of the picture, I became vastly more productive. I hardly missed any school. I rarely got upset. The pain and suffering in the world didn't make me want to kill myself. I stopped fighting with my brother. I got elected vice president of student council. I don't think my carbohydrate balance changed significantly, then or now. I eat a lot of whole grains and a mild amount of sweets.
My ex had a similar experience when she found out she was allergic to corn. She stopped picking fights about stuff that didn't matter. She was able to focus on reading. She didn't let things like a messy kitchen bother her. She stopped having bowel issues. She didn't have super-painful periods (and stopped taking pain relievers with corn as the inert ingredient). She spent a lot less time being sick in bed. She lost some weight. In recent years she's lost a lot more weight, possibly from cutting wheat from her diet. She still eats plenty of carbs; she's just picky about which.
For a subculture that loves delving deep into complex systems, a lot of us nerds and hackers don't know a lot about our own bodies. We've each got an amazing personalized work of distributed engineering with very limited documentation.
I don't know if Aaron had problems with too many carbs, like Amber. Or if he had problems with dairy, like me. Or if he had problems with wheat, like so many in the Venn diagram of Asperger's Syndrome and Geek Focus. Or if his brain didn't play well with some pervasive modern food additive. Nonetheless, there may be something to the theory that Aaron's gut-brain network was compromised.
I just finished the thorough and interesting bio of Aaron Swartz in Slate. Near the end, it describes his last twenty-four hours:
Though Stinebrickner-Kauffman was feeling tired, Swartz was in high spirits, and insisted that they go meet some friends at a Lower East Side bar called Spitzer’s Corner. Swartz treated himself to two of his favorite foods: macaroni and cheese and a grilled cheese sandwich. The mac and cheese was mediocre, but Swartz and Stinebrickner-Kauffman agreed that the grilled cheese sandwich was among the best they had ever eaten.Again, I have no idea what Aaron's gastrointestinal situation was like that. But if I had that kind of dramatic mood swing, I'd blame the cheese.
On the morning of Jan. 11, one week after he’d insisted it would be a great year, Swartz woke up despondent—lower than Stinebrickner-Kauffman had ever seen him. "I tried everything to get him up," she says. "I turned on music, I opened the windows, I tickled him." Eventually he got up and got dressed, and Stinebrickner-Kauffman thought he was going to come with her to her office. But instead, Swartz said he was going to stay home and rest. He needed to be alone. "And I asked him why he had gotten dressed," says Stinebrickner-Kauffman. "But he didn’t answer."
In Guatemalan lingo, "chevere" also means "hot dog," and is written on all the hot dog stands. While this means you can ask for a "Chevere chevere" ("great hot dog"), you can also have this conversation:
"¿Como es?" ("How is it?")
"¿Chevere como un chevere?" ("Awesome like a hot dog?")
"Chevere como millon cheveres." ("Awesome like a million hot dogs.")
(See: Eddie Izzard, "Circle")
Host: "That plate is chipotle hamburgers, the other one is turkey burgers with Asian flavoring."
Me: "I've smelled parts of Asia that I really don't want flavoring my food. What part of Asia, anyway? It could be anywhere between Damascus and Vladivostok."
I then bought some small fireworks made in China and over $30 worth of fruits and roots from Chicanos and Southeast Asians. This fruit salad is going to rock. Come on Sunday, play games, and eat fruit!
The first thing that comes to my mind is a Subway "cold cut trio" sandwich. My wheels start turning, and finally they deliver: "You could make a maiden, mother, crone trio sandwich. Start wit turkey, roast beef, or other fresh deli meat. Add pastrami or pepperoni or other processed meat. Then finish with some potted meat like Spam or croned beef."
One of the great things about eating at a really good restaurant is the ability to try something new and different. That was the best rabbit I've ever had. Of course, it didn't have any competition...
Since returning from Utah I've made pleasing Tamara my biggest priority in the two weeks leading to her birthday. I think I've done a pretty good job.