- A smile is a hammock for your face
- I tried to order an extra large T-shirt from Rome. I received forty shirts.
- Bitcoin is a commodity whose foundation is the artificial scarcity of numbers.
- When @realDonaldTrump said he'd drain the swamp he didn't tell us that the effluent would flow into the Potomac and then into Chesapeake Bay (re: this story)
- Chuck Berry transported listeners to a simpler world where we pursued our crushes, drove fast cars, and the week ended with a rockin' dance.
- Imma let you finish @NCAA, but the March Hare and Mad Hatter are the best #MarchMadness team of all time. #DownTheBasketHole
- The 2010s surge in white nationalism is in large part a reaction to a century of white internationalism.
- Hypothesis: Trump thinks girls have cooties. (re: not shaking Angela Merkel's hand)
- Odd that we live in a culture that stigmatizes seeing a psychologist but not seeing a pastor. They do similar work with different specialities.
- If your house is too big of a landslide risk you can in theory get a new house. If you have a chronic disease you can't move to a new body. (re: America's model of health insurance)
- Sets to the left of me, sets to the right / Here I am, stuck in the middle with ∪ / #MathHumor
- alice@rabbithole> cd wonderland
- When you gaze into the void, the social media ranking algorithm answers back.
- The tyranny of Daylight Saving Time is not that you lose an hour of sleep or an hour of sun. It's that you let a clock decide when you act.
- More people lived in Kentucky in 2010 than lived in the US in 1790. Constitutional suspicion of federal power should apply to state gov't too.
- I'm more confused reading #Perl6 docs as an experienced programmer than Learning Perl as a novice: "Why'd you make the sausage that way?"
- Don't defend the status quo. Describe a better system and work to make it happen. Legislators gonna legislate–ensure they enact your vision.
- Regardless of the benefits of "like a business" governing, Trump's management style isn't fit for leading a country.
- None of us are as strong as all of us are.
- Best part so far of a two-week liquid+purée diet? Eating a bowl full of mayonnaise. #TastyRecovery
- A good approach to cleaning up public discourse on the Internet: you must listen before you speak. (re: a Norwegian news website's new policy)
- There are no high-paying jobs at family ethnic restaurants, but it's a crucial role played by immigrants. #JointAddress (re: proposed immigration policies that focus on high-paying tech jobs)
- For every war we start, we must end two more.
- The best way to stop drugs from coming into America is to grow marijuana in the U.S. #JointAddress
- Key change in gay marriage support was folks knowing more gay people. Let's create opportunities for Americans to meet ordinary scientists.
- Biologists are pro-birth, pro-life, and pro-death.
- Framing: refugees and immigrants are freedom seekers. They're willing to give up even home and family ties to pursue American values.
- Freedom isn't free. It's made possible by hard work and generous support from taxpayers like you.
- Hapless Hank wanted to be the "go to programmer", but instead became the goto programmer.
- Don't want to be subject to any government? 2000+ sqkm between Egypt and Sudan are claimed by neither.
- Honk if you fly south for the winter.
- “I'm not racist, I have black friends!” “This bill isn't homophobic, several closeted legislators voted for it!”
- I don't declare war on xenophobia. I declare peace. May it rest there.
- It's a travesty that America will have to navigate the era of alternate facts without George Carlin
- You can't keep evil out of a country; it doesn't travel on a plane. Evil casts its spores through ideas, sown in a heart fertilized by hate.
- Don't just make art. Be art.
- Humans are my ingroup.
- Obama sought dissenting opinions and input from experts. Trump surrounds himself with like-minded people and thinks he knows everything.
- Hey @POTUS, while you're making it harder to hire foreign workers, please invest in US education system so there are good Americans to hire.
- Halal food in NYC doesn't come in meal deals. It's Allah carte.
- If I told you that you tested positive for antibodies, would you hold them against me?
- Flotsam and jetsam are the mass noun equivalents of odds and ends.
- Pancakes crêpe me out.
- Just to keep things surreal @realDonaldTrump should nominate Hillary Clinton for Secretary of State. She's got experience and is unemployed.
- Strange times when a populace, concerned about decades of job loss, votes in a president whose catchphrase was “You‘re fired”
- Folks advocating for unfaithful electors in next month's electoral college have moved past shock, denial, and anger and are on to bargaining
- Two generations ago, GOP was the party of education, business, & taking blacks for granted; Dems the party of labor & southern xenophobia.
- 2020 campaign promise: free electoral college tuition for all Americans
- To tap into the wisdom of the crowd, maybe pollsters should ask respondents who they think will win their state and the electoral college.
- Next time can we choose the greater of two goods?
- To pay a parking ticket, I have to click "Add to Basket" as if I went to the Municipal Justice Store and browsed around for a nice citation.
- Maybe Republicans would get serious about #climatechange if we called it "Recapitalizing snow and ice banks."
- "Wake of the Flood" was the tidal track of the Grateful Dead's 1973 album. #pun
- Atlas Hugged, in which John Galt attends Burning Man.
- What do you call a really cute cephalopod? Squeed!
- I know I'm not going to eat half the food I bring to @burningman. I just wish I knew which half.
- I'm into second-order psychedelics. I don't take drugs myself, but I thoroughly enjoy consuming the output of those who do.
- When God closes a door He goes to the window, opens it, sticks His head out & yells “I’m as mad as hell and I’m not going to take this anymore!”
- Thank you Mario, but the princess is the protagonist in her own feature film!
- Mallard abduckted. Fowl play suspected. #terrible #pun
We have forgotten that the proper function of the school is to transmit the cultural heritage of one generation to the next generation, and so to make them capable of absorbing ancient learning and applying it to the problem of its own day.– Barry Goldwater, The Conscience of a Conservative, “Some Notes on Education”
Senator Goldwater expressed many points of view in The Conscience of a Conservative which I approach from a very different perspective, yet perhaps none as concisely as this one. He wrote this passage in the context of arguing that the federal government should divest itself entirely of involvement in education, leaving the matter instead to states and local school districts.
The transmission of cultural heritage from generation to generation happens naturally and effectively in the home, at religious and social gatherings, and as young folks interact with their communities. The unique value offered by a school is the opportunity for children and young adults to learn ideas and techniques which were unavailable to their parents. A child sent to boarding school in the 1820s might return as the first person in the history of the family who could read. A young man in 1870 who went off to a land grant college could return home two to four years later and teach his father and their neighbors newly developed techniques in farming. In 1900, a student could leave a town without electricity and pursue a degree as an electrical engineer, learning things in his senior year which were not known to the world when he arrived as a freshman. And in the 1980s and 1990s, my generation played with computers in our public school classrooms and went on to teach our parents, with varying levels of success, how to use the most crucial tool of the modern age.
Goldwater makes clear that he is arguing against John Dewey and progressive education:
Subscribing to the egalitarian notion that every child must have the same education, we have neglected to provide an educational system which will tax the talents and stir the ambitions of our best students and which will thus insure us the kind of leaders we will need in the future.Earlier in the book, Goldwater said that he was in favor of school integration (
In our desire to make sure that our children learn to “adjust” to their environment, we have given them insufficient opportunity to acquire the knowledge that will enable them to master their environment.
I believe that it is both wise and just for negro children to attend the same schools as whites, and that to deny them this opportunity carries with it strong implications of inferiority) but he didn't think the federal government should bring it about (
I believe that the problem of race relations… is best handled by the people directly concerned.). The belief that integration is desirable, yet it's fine if entrenched state political interests deny it, can be easily understood when Goldwater explains that his interest in schools is for the development of future leaders–and the unspoken conclusion that black children in the South would not be the future leaders of those states.
In the intervening half century the Dewey educational position, particularly the emphasis on adaptation to a changing world rather than mastering a static one, has been held widely in colleges and universities. Deans and chancellors are likely to craft mottoes like “preparing students for the challenges of tomorrow” and liberal arts departments emphasize that they teach critical thinking, not just classic knowledge. Yet in many locales primary school (which answers much more directly to local and state political pressure) is shifting away from a path where each generation knows more than their parents, requiring instead that children be taught the same misconceptions that their parents believe. The designated future leaders, of course, are still afforded access to accurate facts through private schools, thanks to their parents’ ability to succeed, whether through a privileged position or personal skill. One of the biggest failings of public education in the last two generations is that it’s funded and run at the local level while the rich and middle class have fled integrated areas, taking their tax revenue and school board engagement away from areas with poverty and students of color and into suburbs with higher school ratings. (There's a great two part piece from This American Life on this topic.)
 I’m using male pronouns in this discussion because secondary education was at that time overwhelmingly meant for men, another major failing of the traditional approach of schools whose goals were to educate a pre-screened set of future leaders.
The turn will come… when Americans, in hundreds of communities throughout the nation, decide to put the man in power who is pledged to enforce the Constitution and restore the Republic. Who will proclaim in a campaign speech: “I have little interest in streamlining government or in making it more efficient, for I mean to reduce its size. I do not undertake to promotte welfare, for I propose to extend freedom… And if I should later be attacked for neglecting my constituents’ ‘interests,’ I shall reply that I was informed their main interest is liberty and that in that case I am doing the very best I can.”– Barry Goldwater, The Conscieence of a Conservative, "The Perils of Power"
Folks on the left are often surprised when Republicans support economic policies which negatively impact a majority of their constituents. Some folks use this observation as a rhetorical barb (e.g. these tweets). But for politicians inspired by Senator Goldwater and the last half century of conservatism, policies which favor liberty (freedom from) at the cost of opportunity (freedom to) are the goal, not an accident.
While the political and military tactics in this particular case and how the North Koreans may react or retaliate are fascinating, I'd like to take a step back and look at the bigger picture. The U.S. military is using "cyberweapons" and committing what one might term "cyberwarriors" in an offensive operation attacking infrastructure developed by a foreign state. This is also not a new policy: ample evidence indicates that U.S. and Israeli intelligence agencies built and deployed the Stuxnet worm to cause physical damage to nuclear centrifuges at Natanz in Iran, setting the Iranian government's nuclear ambitions back by a few years (and driving them batty in the process). The Stuxnet attack was authorized by George W. Bush and reauthorized by Barack Obama. The North Korean attacks were authorized by the Obama administration (probably the president himself) and is now under the direction of the Trump administration.
In many ways a "cyberweapon" is just a collection of software vulnerabilities packaged in a way that helps the attacker obtain information from or disrupt the operations of a particular network or computer system run by a target. A cyberwarrior and a common hacker use, by and large, the same tools–they differ primarily in motives and focus. The same vulnerability in, say, Microsoft Windows can be exploited to steal bank account credentials or to further infect an industrial control system and disrupt a nuclear fuel operation. The Stuxnet attack on Natanz and the current North Koraen attacks have had significant physical-world effects: large and dangerous objects were destroyed. Criminal and ideological hackers have thus far focused on digital payloads–stealing data, transferring money–but there's nothing preventing non-government attackers from creating havoc in the physical world, from disabling the power grid to releasing a flood of water from a dam to potentially triggering a nuclear meltdown.
Unlike the military hardware of the last century, governments, businesses, and individuals around the world generally use the same software and hardware from a small group of companies with worldwide scope. The Microsoft Windows on laptops, Android on smartphones, and firmware in Cisco routers is code that's used by people in every country. By and large, there's no "Iranian software," "North Korean software," or "American software"–with the Internet, it's all "world software." Every security bug that a military or intelligence agency discovers but doesn't disclose is one that goes unpatched by the vendor and could be exploited by another government or crime gang, harming the citizens, businesses, and government agencies that the military and spy agencies are tasked with protecting. This presents a particular problem for an organization like the NSA which have an explicit commitment to both defend American computer and communication networks while intercepting foreign communications of interest.
Physical war and military operations are, in large part, studied and debated in the open. The public and our elected representatives don't know the details of all military plans and technologies, but we're broadly aware of where military force is being used offensively and defensively and what sorts of tools and tactics we're comfortable with the military using. The country is able to have a public debate about topics like whether we should invade a country, how much money we're willing to spend to achieve military objectives, and whether we consider torture or cluster bombs to be acceptable tools of war making. (The pro-war advocates are often able to start their framing of the issues well before the public starts to engage in the debate, so we tend not to have a very effective public debate, but the opportunity is still there.)
"Cyberwar" and offensive security compromises by the government, by contrast, have been conducted under a thick veil of government secrecy. The people of the United States and our representatives in Congress have not had an opportunity to have a public debate about whether we're comfortable with the military, without declaring war, instigating digital battles with sovereign states. We haven't had a proper conversation about what sorts of cyberattacks we're comfortable and which are beyond the pale. We haven't effectively discussed the balance between concealing and weaponizing computer vulnerabilities for attack and defending our country's digital infrastructure by helping companies patch software when intelligence agencies find bugs. And we really haven't come to grips with what we'll do when a "cyberweapon" targeted at a narrow military objective is too effective and causes unintended damage elsewhere on the Internet, including to American assets. We also haven't taken an opportunity to establish treaties governing digital offensive activities, so other nations may take a cue from U.S. operations and decide that hacking is a legitimate tactic and invest in their own "cyberarmies" which attack and hurt American computer networks.
There are reasonable arguments both in favor of and opposed to offensive military hacking. Proponents can point out that a well-executed cyberattack has the potential to achieve its objective cheaper and with a lot less loss of life than a conventional military operation. Opponents can point out that a hacking operation that gets out of hand–as the Stuxnet worm did, infecting millions of computers around the world–it's a lot more work to halt than just calling off the bombers and withdrawing the troops. But so far these debates have been held quietly behind closed government doors and in memoranda stamped Top Secret. The public doesn't know what conclusions were reached and their interests were not well represented. Once Congress is done with their current project of attacking affordable health care and defunding public agencies, it would be great if they could demand that military, intelligence, and executive agencies include the American people in the conversation about the rules of engagement for offensive hacking. I'm not holding my breath, though.
Anyone interested in this topic should watch the fantastic documentary Zer0 Days. It features a detailed technical explanation of how the worm works from the security researchers who studied it (and impressive cinematic techniques to make this explanation engaging), insights from anonymous NSA employees, and some remarkably frank on-the-record interviews with government officials. I'd read the initial reporting on Stuxnet in 2010, but the movie exposed several fascinating facets of the story of which I was unaware. The interviews with government-associated figures help shape the views I expressed above, and some of the officials seem to share my position.
Bruce Schneier often writes well about this subject, too.
George Lakoff is a professor of linguistics and cognitive science at UC Berkeley. I first encountered his work in Metaphors We Live By, a fairly academic book which argued that metaphors aren't just manners of speech, they actually provide structure to how we think and form a framework through which we perceive the world. This led him to research on frames, "mental structures that shape the way we see the world" and investigations on how liberals and conservatives think and the frames they use. He published Don't Think of an Elephant in 2004 as an accessible and practical guide for progressives to understand how people make political choices, why conservatives are much better at framing than progressives are, and what the left needs to do in order to activate progressive frames in the minds of voters. The All New Don't Think of an Elephant! is a 2014 edition which adds chapters and updates many of the essays to cover political developments during the second Bush term and the Obama presidency.
Frames help us make sense of the information we receive. For instance, the frame "Countries are rational actors" provides us tools for interpreting international relations and actions of governments. Given that frame, a speech by a particular politician or an attack by an army is evaluated as though it's a single person (the country) following a considered strategy. An alternate frame, say "Countries are herds of animals," would lead to a different conceptualization of the same presented facts, like an assumption of acting on instinct and a focus on the power dynamics within a government.
Frames are wired into our brains: the more often the language associated with a frame gets activated, the stronger the neural linkages become. When information is presented which doesn't jive with the frames in our brain, cognitive dissonance results. Cognitive dissonance is uncomfortable, so we tend to resolve the situation by rejecting the information or selectively reinterpreting it so that it can form a narrative supported by the frame.
The most important insight in the book is that people don't vote based on a list of policies and they don't necessarily even vote for their rational self-interest. They vote for candidates whose message activates the frames that drive their values. People aren't swayed by facts, they're swayed by narratives that resonate.
Lakoff identifies the major frames for political values as the "strict father model" and the "nurturant parent model." The former leads to values like law-and-order policing, military power, and "tough love" economic policies. The latter leads to values like restorative justice, soft power diplomacy, and opportunity-focused economics. Everyone has both frames in their brain to some degree, and political ideology reflects the frame which is stronger, or is present in more aspects of their life. He also talks about "biconceptuals," folks that have a balance of both models, the cognitive version of "swing voters."
The family models do a great deal to explain why positions which seem to be logically unrelated are so correlated in the political sphere. Why do so many folks both oppose gay marriage and support use of military force to achieve foreign policy objectives? Corporal punishment (or the threat thereof) is how order is established in a strict-father family, and gay marriage violates the whole premise of a strict-father family, because there's either no father (two women) or no single father figure (two men). Why do so many folks oppose firearm ownership and support public education? In a nurturative-parent family, providing opportunity to kids has a very high value (free public school provides opportunity even to kids whose parents don't have any resources) and guns represent violence, which is anathema to the protection and nurture values.
Conservative elites, starting with Barry Goldwater and the Powell Memo, have spent several decades carefully experimenting with ways to frame their policy goals so that they will resonate with the values frames of American voters. Progressives and liberals, on the other hand, have not had an organized approach to framing and tend to run on a set of specific policies, not on a set of values. Since the left haven't developed language to activate frames, they tend to use the frames provided by conservatives. This is self-defeating, because repeating the conservative framing of an issue activates the same neural pathways, even if the idea is negated (hence the title of the book). For instance, conservatives developed the phrase "tax relief," which activates a metaphor of taxes as a burden. If a liberal says "I'm against tax relief," it reinforces the idea that taxes are burdensome and the voter is left wondering why the politician is in favor of burdens. If the liberal instead recast the issue in their own frame–"I think the wealthy should contribute their fair share"–it would activate the frame that tax is a shared investment in society.
Lakoff advocates for progressives to rethink how they present their ideas. He urges the left to shift from talking about facts and policies to talking about values, principles, and policy directions. He instructs people to affirm the progressive world view rather than use the negated language of the conservative world view. He tells politicians to stop focusing on policy polls and start presenting a coherent narrative. And he recommends the left invest–intellectually and financially–in creating organizations (think tanks and so on) devoted to finding ways to frame progressive values in ways that resonate with American voters. This is a long-term investment: the right has spent over four decades building their current ideological power position and the left can't suddenly adjust the neural circuitry of the public next month or even this year. But the longer progressives wait, the more they'll lose ground and the harder it will be to make progress.
The book's final chapter, "How to Respond to Conservatives," has some solid tactical advice, including showing respect, remaining calm, and positively reframing the issue. It ends with the crystalized guidelines: "Show respect; Respond by reframing; Think and talk at the level of values; Say what you believe." His approach is good for spreading the progressive world view, but I think there is occasion to use the frames of the "other side." When you're working on a specific policy measure like climate change or health care, it's important to have allies on both sides of the spectrum–this eases passage of an initiative and makes it less likely it will be repealed when the legislative balance of power shifts. Shifting a Republican member of congress from a strict-father model to a nurturative-parent model is a long game indeed, but convincing the same representative that climate change is a threat to national security or that it will create an undue burden on business might get an important piece of legislation passed. This is also communication that can be more focused: a letter to a legislator can be tailored to resonate with the specific framing a person has demonstrated whereas a letter to the editor tries to activate the framing of thousands of different people.
My goal in reading this book was to improve my ability to communicate with people who don't share my worldview, and it definitely helped. I'm someone who's immersed in facts and tend to overcommunicate details. This is important when figuring out how to create software or working with scientists to learn how the world works. But it's a hopeless technique for reaching non-experts, and by necessity most politicians, and certainly most voters, are not experts on a vast majority of subjects. I intend to do work to verbalize my own values and organize them into a coherent story, one which I hope can inspire folks who are already on my side, resonate with folks who aren't there yet, and help folks with a strict-father model empathize with the nurturative values.
On Monday, I had a laparoscopic Heller myotomy and fundoplication. It was performed at Swedish Medical Center in Englewood by Dr. Reginald Bell, Nurse Practitioner Kate Freeman, and an anesthetist whose name I very quickly forgot.
My almost eery sense of calm about the surgery continued on the day of the procedure. I think scheduling it for noon rather than 10am helped a lot. I was really relaxed and upbeat in pre-op and got to hang out with my wife and our friend Michelle–who happens to be a hospital chaplain–for at least an hour. We also had a great conversation with Deb, the nursing liaison. Michelle said this position was created for Deb, and I think it's a model which should be adopted widely: she acts as the point of contact for family members, providing patient status and helping the family navigate the hospital and recovery process. She overheard my wife calling my dad to ask him to pick up my prescription in Boulder before the pharmacy closed but after we got home (since he'd need my ID); Deb made a couple calls and got the prescription sent to the Walgreens across the street from the hospital so we didn't have to race the clock.
I would love to provide a fascinating narrative about the experience of having my torso inflated like a balloon and tools cutting my lower esophageal sphincter, relocating my stomach (I had a 3cm hiatal hernia), and wrapping it around my esophagus. (Un)fortunately, very quickly after I was wheeled into the super-bright operating room and I shifted onto the operating table, the anesthesiology drugs kicked in and my next memory is grogginess in post-op.
My "wake up, the anesthesia is wearing off" progress was counterbalanced by hydromorphone for pain relief, so I kept closing my eyes and trying to sleep in recovery. But the act of falling asleep would cause my breathing to get shallower and the pulseox would trigger a noisy desat alarm, pulling me out of sleep. This process went on for an hour or two–taking deep breaths was hard because I had new stitches in my diaphragm–until the drugs wore off enough that I was fully conscious and just in dull pain. I spent another hour or so working up to walking around the floor and drinking water, though a few sips of a protein shake proved too adventurous.
Concerned about the breathing danger posed by the opiates, I only took acetaminophen (Tylenol) for pain. I'd been expecting the pain to be both sharper and stronger; instead, it was more of a big ache. I also hadn't expected my shoulders to hurt significantly more than my abdomen (where the incisions were) or chest (where the esophageal operation took place). The shoulder pain was apparently partly from laparoscopic gas but mostly because of the diaphragm stitches. I had not previously realized the connection between shoulders and diaphragm, but I think it may explain some of my recurrent issues. I'll need to notice their relation in the future.
I had the presence of mind to pee right before the procedure. Through post-op and several hours at home I wasn't able to urinate, despite having gained 7 pounds of liquid that day. After my third bout of trying different positions on the toilet produced no results, I decided to try taking a shower, since I often reflexively open my bladder when immersed in water, even if I just peed. To my surprise, I didn't even have to turn on the water: stepping on the wet floor of the shower was enough to remind my nervous system how to let go.
The first night of sleep was a challenge. I find it difficult to fall asleep on my back, so I spend most sleep time on my side, which is a big challenge with painful shoulders. Five seconds after lying down, I could tell that my bed was not going to be conducive to sleep. I set up some thick pillows on the arm of a couch so my head could be significantly elevated and laid on my back with a pulseox on my finger. My wife curled up on the other couch and asked my oxygen levels when she'd hear me rustling around. She's so sweet.
Other than being tired, having sore shoulders, and a very raspy voice, I felt really good on Tuesday. I had wisely planned to take the rest of the week off work and set no goals for the week beyond resting, hydrating, and reading books. I spent the day sitting on the couch, reading about public discourse and drinking water and vegan protein shakes. The recommended diet progression is two weeks of liquids, two weeks of soft foods, and then careful reintroduction of more challenging items to swallow. This week I've progressed from coconut water and nutritional supplements through apple sauce, gelatin, fruit smoothies, yogurt, creamy soup (think split pea), and ice cream. I think I need to cut back on sugar content, not because it'll make me fat (that's what I'm hoping for), but because my mouth feels pretty overwhelmed. After ⅔ of a pint of vanilla coconut ice cream last night and a probiotic, my stomach was feeling pretty queasy and I woke up with some really intense heartburn and liquid stool at 5:30, so I think I'll back off on the pint-a-day-for-weight-gain plan I concocted last fall.
After leaving the hospital, the pain was never enough that I wanted to take an opiate. I took Tylenol for less than three days, and a COX-2 inhibitor took care of aches for the rest of the week. My body hurts less a week after surgery than it has many times after a week sitting at a desk. With luck, this spring will feature fewer pharmaceuticals than any season since the early autumn of 2014.
My accumulated vacation time is usually focused on travel and adventure, so since I started working professionally I haven't really spent a week just relaxing at home, except when I'm sick enough that my brain doesn't work well. Spending several days in a row casually eating, reading, thinking, and listening to music brings back a sense of what I really enjoyed in college. I should do this six-day-weekend thing more often :-) I also had a really relaxing craniosacral massage on Friday which put my perisympathetic nervous system in a state conducive to some really good sex, so hopefully my libido will recover in tandem with my GI system.
While my body feels really good (the major shoulder pain only lasted about three days and my abdomen is only mildly tender), I'm planning to work from home for the next week so I can have a high-powered blender and a fridge full of low-viscosity foods handy. (A career as a software engineer and an employer who believes in flexible working conditions have been crucial to my ability to handle this disease.) My intolerance to dairy products would've made this adventure difficult two decades ago, but I've been able to find cashew yogurt, garbanzo pesto, and soy sour cream, and coconut/tapioca cream cheese cream, adding to hummus and guacamole in my "condiments I can eat with a spoon" repertoire. Between soy, almond, hemp, macadamia, coconut, and oat, I've also got a tasty variety of liquid milk alternatives.
I occasionally walk past a bag of crunchy snacks and instinctively start to grab for a cracker or something. We loaded up on frozen fish yesterday and I'm excited about my office diet plan next week of soggy Cheerios, tuna fish, egg salad, and canned peaches. I'm not craving solid food so much as I am excited about it, as though I'll be embarking in a week on a long-planned trip to a regular vacation spot: at once familiar and novel.
Thanks to everyone who sent me well wishes and offered to help. Not bringing me food and inserting themselves into my healing process turned out to be the best assistance folks provided. My mother-in-law's delivery of soup turned out to be somewhat stressful (mostly for my wife) and not particularly helpful (since I'd already collected weeks worth of liquids).
Programs are a major problem for attempts at unity. As soon as a policy is made specific, the differences must be addressed. Progressives tend to talk about policies and programs. But policy details are not what most Americans want to know about. Most Americans want to know what you stand for, whether your values are their values, what your principles are, what direction you want to take the country in. In public discourse, values trump policies, principles trump policies, policy directions trump specific programs. I believe that values, principles, and policy directions are exactly the things that can unite progressives, if they are crafted properly. The reason that they can unite us is that they stand conceptually above all the things that divide us.– George Lakoff, The All New Don't Think of an Elephant!, “What Unites Progressives”
Having those shared values, largely unconscious and unspoken, is not good enough. They have to be out in the open, named, said, discussed, publicized, and made part of everyday public discourse. If they go unspoken, while conservative values dominate public discourse, then those values can be lost–swept out of our brains by the conservative communication juggernaut.
Don't just read about these values here and nod. Get out and say them out loud. Discuss them wherever you can. Volunteer for campaigns that give you a chance to discuss these values loud and clear and out in public.
Put another way, values, principles, and policy directions are how you build a movement. Policies are how you implement the vision once the movement has critical mass. When building a movement you don't worry too much about folks with a drastically different world view; you're just trying to find all of your friends. But when it comes to policy, it's important to work with folks from “the other side.” A policy which is supported by many members of some movements has a better chance of surviving than a policy which is supported by all and only one team.
Unfortunately, all too many progressives have been taught a false and outdated theory of reason itself, one in which framing, metaphorical thought, and emotion play no role in rationality. This has led many progressives to the view that facts–alone–will set you free. Progressives are constantly giving lists of facts.
Facts matter enormously, but to be meaningful they must be framed in terms of their moral importance. Remember, you can only understand what the frames in your brain allow you to understand. If the facts don't fit the frames in your brain, the frames in your brain stay and the facts are ignored or challenged and belittled.
When George W. Bush arrived, we got "compassionate conservatism." The Clear Skies Initiative. Healthy Forests. No Child Left Behind. … This is the use of Orwellian language–language that means the opposite of what it says–to appease people in the middle as you pump up the base. … Imagine if they came out supporting a "Dirty Skies Bill" or a "Forest Destruction Bill" or a "Kill Public Education" bill. They would lose. They are aware people do not support what they are really trying to do.
Orwellian language points to weakness–Orwellian weakness. When you hear Orwellian language, note where it is, because it is a guide to where they are vulnerable. They do not use it everywhere. It is very important to notice this and use their weakness to your advantage.
– George Lakoff, The All New Don't Think of an Elephant!
I went book shopping last weekend so that I would be better prepared to have conversations with conservatives about issues like climate change. This book sounded like exactly what I was looking for. James Hoggan is a professional in the public relations field. He runs DeSmogBlog, a site devoted to "Clearing the PR pollution that clouds climate science" and has published a book on the topic. He set out to write another book devoted to climate advocacy and highlighting climate facts, but he realized that there was a bigger problem: the public space in which our society discusses issues and comes to agree on policy is polluted, sickening democracy and making progress on any tough issue almost impossible. So he decided instead to explore what was clogging the public square and how we can engender more productive communication and enable action on important problems.
Hoggan structured the book's chapters around people he interviewed, most experts in some mode of communication. The result is a book where each part is clear and interesting, but it can be difficult to find an overall narrative. I came away with several important insights but without a full practical framework for making things better. The epilogue does help tie things together, and I'd recommend reading that first, then deciding if you want to read the rest of the book.
Hoggan's background concern of climate change and environmental concerns shows up throughout the book; most chapters share the interviewee's thoughts on how people relate to environmental facts or arguments. And while I bought the book hoping to improve my ability to have conversations around climate change, I think the book would have been stronger if he'd dug into specifics on several distinct issues. He mentions migration, gun violence, and other "big challenge" problems in passing but never talks about how someone might approach those particular problems using the ideas in the book.
Some of my key takeaways:
- Experts on a topic (e.g. scientists) make decisions based on facts, rational debate, and deep investigation. Most non-experts make decisions based on emotion and narrative.
- In a modern democracy, the support of non-experts is needed for any major policy. Facts are important in deciding what to do, a story (particularly one with values or a moral) is crucial in getting people to do it.
- People have a self-conception in which they generally do the right thing and believe in the truth. When something challenges this view, people experience cognitive dissonance, which is uncomfortable.
- If new information is presented in a way that's too shocking to that belief, people are more likely to assume that the information is wrong than that they've been wrong. It's therefore very important not to structure an argument as "You're wrong" or, especially, "You're a bad person." Instead, find shared values and express a policy proposal as a way of expressing those values.
- Tell your own story; otherwise people who oppose your idea will tell your story in a way that undercuts you.
- Once you've told your story, avoid responding to attacks. It's easier for folks to see an attacker as offensive if you aren't playing defense.
- Anger is important in motivation, and appealing to anger "on your side" can be a good way to get folks involved in an issue.
- But it's super important to drop the anger as you start talking to folks who don't get angry by the same things you do. If someone feels that you're speaking to them out of anger or that you perceive them as an enemy, they aren't likely to take your words to heart.
- Self-righteousness and purity can hurt your position.
- If the public sees two sides loudly asserting their own position, they aren't in a good position to evaluate the arguments and they may conclude that the issue is just a matter of personal preference or align with the side that has better hair or a slicker marketing delivery.
- Change is scary.
- People resist imposed change more than when they feel they have agency.
- Inevitability is a terrible motivator.
- To take action, people need to feel that there's hope and that what they do will have an effect.
- Compassion is key to communication.
- You can't make progress working with an enemy. But you can make great progress working with a fellow human being that you understand, respect, and disagree with.
One of the best paragraphs in the book comes in the epilogue:
People don't start out mired in hostility. The situation evolves. When someone publicly disagrees with something we feel strongly about, we perceive them as aggressors and we begin to question their motives and intentions. When people criticize or condemn our cause or our reasoning, our defense mechanisms kick in. Anger simmers and escalates. When people on both sides of an argument draw their positions from the perceived bad behavior of the other, they eventually start treating each other as enemies, and this provokes a perpetual shoving match and eventual gridlock.
The scientific community assumes the same rules of communication are always applicable and rational, that people are attentive, open minded, persuaded by facts and believe that those who are presenting information are people of goodwill, and not deliberately trying to manipulate them. But none of those things are true.– James Hoggan, I'm Right and You're an Idiot: The toxic state of public discourse and how to clean it up, chapter 1 with Daniel Yankelovich and Steve Rosel
Yankelovich and Rosell have identified a process that they call the public learning curve that describes maturing public opinions, where people's views evolve from poorly informed reactions to more thoughtful conclusions. The three-stage process begins with building awareness and consciousness (where advocates and the media typically do a good job). The seecond stage involves working through wishful thinking and denial, resistance to change and mistrust, grasping at straws, deliberate obfuscation and lack of urgency (which is where dialogue comes in). The third part of the learning curve is when people come to resolution (which is handled by decision-makers and government institutions). "Much of our work focuses on improving the 'working through' stage, which our society does not handle well and where critical issues like climate change can get stuck for years or decades," said Rosel.
It is not a wise strategy to define a situation as inevitable or out of control. "This is a negation of politics–because you don't do politics with inevitability," explained Latour. If you send a message to people that there's no other possibility, that it's too late–the result is inaction. Latour suggested that the message must give them the will to find a way out of the dilemma.– ibid., chapter 7 with Bruno Latour
With a calcium channel blocker, I was able to eat a normal day's worth of food and not regurgitate most of it, so I managed to gain about 10 pounds in a month.
Making further progress on my annual goal of gaining 30 has been challenging, and I've hovered around 120 for the past month.
I weighed in at 120.5 on Saturday morning.
After a weekend of clear liquid, I'm heading into surgery at 115.
I'm quite glad I was able to invest in that fat buffer.
Here's to hoping I'll be able to swallow a lot of soft calories in the next two weeks.
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.
I was prescribed a calcium channel blocker, which relaxes smooth muscles for a few hours. I've been taking it before meals for the past six weeks and holy cow is it wonderful. Like night and day is the contrast between my pre-diagnosis experience and my eating ability on the medication. I take a pill, wait 30 to 45 minutes, and have a meal. A full meal. That only takes an hour or two. Not six hours spent eating a modest plate of hummus, tuna, ham, and carrots. And on the drug I can eat things of pretty much any texture: I ate ground beef on a hamburger bun with lettuce and tomato recently, with only mild discomfort and occasional pauses. Three months ago, any of those foods individually would have been a risky venture.
I get a wry grin when I tell folks that my new year's resolution is to gain thirty pounds. I was able to put ten pounds back pretty quickly. I even gained three pounds in one day early on, which was a very worrisome trajectory, but it turned out it was just due to water retention: calcium channel blockers dilate your blood vessels and cells too, so my feet and ankles got kinda puffy. I've kind of stalled out around 120 lbs for the last few weeks, hitting as high as 123 and as low as 119. I feel way better though, since I'm able to get enough water every day.
Taking a pill before each meal isn't a perfect solution. I need to time it for about 45 minutes in advance, which can make a restaurant visit tricky (Will there be a waiting list? How long will the dish take to cook?). It can also wear off before I expect, leading to a couple hours of discomfort and regurgitation at the end of a meal. And I sometimes get caught in a situation where a light snack would be ideal, but the options are pretty constrained. This isn't the first time I've had Mi-Del ginger snaps play an important role in healing.
January was the month of doctor's visits: eight (four in Denver), plus twice-weekly physical therapy. (Compare to last January when I averaged a doctor's visit every other day.) My rheumatologist, gastroenterologist, and two foregut surgeons thought the achalasia and psoriatic arthritis were unrelated; Dr. Lutt guessed that the study correlating achalasia to uveitis was the other type of uveitis. Psoriatic arthritis leads to inflammation in the connective tissue and intestines, neither of which are related to the sphincter or esophagus, so scratch that theory. I've also been curious if Chagas disease might be causing my achalasia–I was in Central America 7 years ago, which is close to the typical incubation time. Both surgeons said a Chagas diagnosis wouldn't change anything from a surgical perspective, but it comes with some worrisome cardiovascular issues, so I'll see what the CDC says after they closely inspect my blood for parasite antibodies.
Achalasia can be treated with several procedures, all of which address the constricted esophageal sphincter and not the squeezing abilities of the esophagus itself. The conceptually simplest is a balloon dilation: feed an inflatable tool down the throat and carefully expand it inside the sphincter. This tears the sphincter muscle fibers a bit, so they don't constrict as much. This isn't permanent–the muscle will eventually heal–but it could last ten or fifteen years (or potentially just a year and a half). Another temporary option is Botox, though its duration is usually measured in months and it leaves scar tissue, so it's only recommended for the old and frail.
There are two surgical options, both myotomies which cut the sphincter so that it opens easier. The Heller myotomy is has been performed for over a century, is well studied, and has reliable results. It's performed laparoscopically, with instruments inserted through small incisions in the abdomen and operating on the esophagus from the outside, underneath the skin. This is generally complemented by a Dor fundoplication, which wraps the stomach around the esophagus. When the stomach contracts, it will close the sphincter, helping prevent acid reflux and heartburn. The POEM procedure is fairly new: developed in Japan in the late naughties and brought to the U.S. in 2010. POEM works from the inside, tunneling between the mucosal and muscle layers in the esophagus, and doesn't include a fundoplication. POEM has the advantage of a quicker recovery time: one week on soft food and back to work in less than that, whereas Heller is followed by two weeks of a liquid diet followed by two more weeks of soft food; it also comes with a week off work and a month of not lifting heavy objects.
The fewer cuts, quicker recovery, and earlier return to a normal diet make the POEM a very attractive option. In Denver, Dr. Emily Speer has experience performing the procedure, but won't have the equipment until the latter half of the year, and she'll then need to assemble and train a team of POETs to support the surgery. Dr. Reginald Bell is an old and experienced surgeon who's probably performed more myotomies than anyone in Colorado. He said he performed the POEM a few times but found that his hands felt more comfortable with Heller; since his patients didn't have significantly better outcomes with the POEM, he decided to stick with what he does well. When there are sharp instruments next to one's throat, it's important they be wielded by someone who can use them properly.
I've therefore got four reasonable choices. Do the tried-and-true Heller procedure soon with the very experienced surgeon. Wait a year and do the POEM with the freshly-trained POEM surgeon. Travel to Portland and do the POEM with the U.S. experts, then recover at a friend's house for a few days. Get a balloon dilation and hope it lasts several years, then get a myotomy when the sphincter starts overconstricting again. I was initially inclined towards the balloon-and-wait strategy since I was worried that my weight loss and weakness would make surgery recovery challenging. The tearing from dilation makes subsequent surgeries more challenging (POEM moreso than Heller) and my weight gain in January has made me think I'll be better able to recover from a surgery this year than in my late forties. Waiting a year would be attractive, but there's a big risk: calcium channel blockers tend to stop working after "a few" months, so I might fall back to the realm of eating-challenged for months before the procedure. The risk of being forced into a soft diet for several months in advance of a POEM doesn't seem like a good tradeoff for avoiding a month of liquids and soft foods after Heller. Finally, I called The Oregon Clinic, where the national POEM experts are and where I know enough Rangers that I could probably find a spare bedroom and good friends to aid recovery. They would want to schedule some tests in late April and then schedule a surgery after that, which would mean early summer at the soonest. Between the risk of the drugs becoming ineffective this spring and the challenges of a recovery in an unfamiliar environment, this didn't seem like a great plan.
Dr. Bell, after confirming that I'm an engineer, pointed at his frontal lobe and said "I think you know that people don't usually make this kind of decision up here," and then circled the base of his skull, saying "they make it somewhere back here." So after a month of reading, interviewing, mulling, and listening to my nurse practitioner wife's insights about healing and surgical recovery I decided that a Heller when I know I'm feeling good is better than a long wait, and a risk of backsliding, for a quick recovery down the road.
The next step toward long-term health is on February 20th. I'm a little nervous, but mostly I'm excited. Fingers crossed, sphincters open.
I am a lifelong Colorado resident and I’ve voted in every election since I turned 18. I am writing to express concern over the executive order regarding visas that President Trump is expected to sign today. This order would restrict U.S. entry for people from Iran, Iraq, Syria, Yemen, Libya, Sudan, and Somalia, even for people who already live in America. I oppose this ban for three reasons: it’s bad for American business, it won’t make us safer, and it hurts families. I urge you to call President Trump and let him know that this order is not consistent with the values of America or our people.
Life in all of those countries has been quite challenging in recent years and many folks have decided to seek a better life in America. Many of the people who have fled are highly educated and have been making valuable contributions to the American economy as scientists, engineers, doctors, and more. From Iran in particular the United States has benefitted from over three decades of contributions from expats. Several highly skilled Iranians have helped my company deliver billions of dollars of value in the American economy.
This policy would not make America any safer. In the list of terrorist attacks in the U.S. on Wikipedia the only perpetrators I found connected to those countries were two by ethnic Somalis and one Yemeni man; all three cases had small impact. Meanwhile, the 9/11 attackers were predominantly from Saudi Arabia, which is not covered by this ban. The people who emigrate to the U.S. are typically opposed to these countries’ governments and are seeking a more stable life than the chaos at home.
Finally, this order would hurt families. Folks living in America–many of them U.S. citizens–would be unable to visit their families or have family members visit the U.S. This could break up marriages, strand children, and keep Americans from attending family weddings and funerals.
In a speech whose overall tone was jingoistic nationalism, this stood out to me:
We will seek friendship and goodwill with the nations of the world – but we do so with the understanding that it is the right of all nations to put their own interests first.It sounds like Trump misunderstands friendship. When a good friend is in need, we put aside our own interests to help them out. We lend our friends money at no interest when they're in a jam. We put our own reputation on the line to vouch for a friend's character. We sit our friends down for an uncomfortable conversation when they need an intervention.
Friendship is a long-term relationship that often involves personal sacrifice to help the other. We do this because at some point, at a time unknown and with no guarantee, the friend might be in a position to return the favor. Trump's line does not describe friendship. Perhaps the term he was looking for was "business partner."
Trump launched his campaign by impugning Mexican immigrants as rapists and drug dealers and made anti-immigrant bluster a cornerstone of his rallies, so it's no surprise it was a key point in his inauguration speech.
Every decision on trade, on taxes, on immigration, on foreign affairs, will be made to benefit American workers and American families.There's actually a really elegant solution to this. If you make it easy for immigrants to become citizens, more Americans will be employed and more American families will contribute to society.
Trump continued on one of his favorite topics, borders. (Although the U.S. only has two, and Trump only seems to care about one of them, so perhaps he should make it singular.)
We must protect our borders from the ravages of other countries making our products, stealing our companies, and destroying our jobs… We will bring back our jobs. We will bring back our borders. We will bring back our wealth. And we will bring back our dreams."We will bring back our borders" is an odd choice of wording. Make America 48 Again? Maybe he wants to renegotiate the Louisiana Purchase as a public-private partnership.
The first sentence is somewhat surreal too, and not just because "ravages" seems out of place. Despite corporations counting as "persons" under U.S. law, a foreign intelligence agency can't kidnap or steal a company. And I'm not aware of major American companies disincorporating and moving to another country, perhaps because Delaware is such an effective tax shelter. (There have been some notable international purchases of American companies, perhaps none more ironic than Budweiser being produced by a Belgian firm.) Additionally, the United States is still the top manufacturer in the world, we just mostly make stuff with really fancy machines and not a lot of people (high capital, low labor). Finally, a lot of wealth has stayed in American accounts: since the companies are still American, their stocks are traded on American exchanges, and the corporate executives haven't been outsourced, wealth gains from globalization haven't fled the country: they flowed to the American 1%.
Finally, Trump is personally an odd champion for trade protectionism and a call to bring jobs back to the U.S. He makes a lot of money from hotels and resorts around the world, employing thousands of non-Americans. It would also be nonsensical to fill those jobs with U.S. citizens: you can't outsource cleaning a hotel room in Manilla to someone in Toledo. These properties also put Trump in a compromising position in his quest to put America's interest before its friends: will he put the U.S. first if, say, Trump Towers Istanbul becomes a pawn in negotiations with Turkey? Would he stick to his protectionist stance if his family was offered the chance to build Trump Tower Guangzhou?
I am writing you on the occasion of Martin Luther King Jr. Day to express support for immigrants and disenfranchised citizens and because I am concerned about the political tone in the United States. Dr. King expressed a dream, based in the ideals set forth in the founding documents of our nation, that everyone in America would be judged not by the color of their skin but by the content of their character. And while major strides were made in the second half of the 20th Century, this dream often seems a long way off. The president elect and many other prominent voices have proposed a vision for America which seeks to deny the American dream based on demographics, denying people the chance to prove their inherent worth.
America has been built by half a millennium of immigrants, creating wealth and innovation like the world has never seen. The first of my ancestors to arrive came from England in the 1600s; the last arrived from Norway and Wales near the end of the 19th Century to farm and mine in America, working hard to support their families and, in the process, helping America grow. Today’s generation of immigrants contributes immeasurably to American society and the United States economy, from migrant farm workers to the CEO of Google.
Mr. Trump and many other prominent voices have tried to foment xenophobia and anti-immigrant sentiment for political gain. Mr. Trump has proposed signaling out members of specific religious groups for enhanced government surveillance, building a fence to rival the Great Wall of China at a cost around 40 billion dollars, and deporting children (future American entrepreneurs and laborers) for whom the United States is the only home they’ve ever known. This plan not only goes against the American values that Martin Luther King elucidated, it also works against our economic interest. For the U.S. economy to thrive in the coming generations, the country must grow. The native-born American population is aging and shrinking. Immigrants tend to be young and work hard, filling important roles, spending money in the American economy, and fueling job growth. The United States risks an economic and budgetary crisis as our population ages if we do not welcome the innovation and determination of immigrants seeking the American dream, fleeing war and economic despair abroad, just as immigrants have done for the last four centuries.
As my voice in Washington, I call on you to speak out, both privately and publicly, when Mr. Trump, his associates, and other members of the political establishment make judgments of people based on the skin color, national origin, gender, religious beliefs, or sexual orientation. Furthermore, I urge you to sponsor and vote for legislation which reforms the U.S. immigration system, paving a path to citizen ships and creating an egalitarian and welcoming nation. I also urge you to take action to stop discriminatory policing, reform racially biased sentencing guidelines, ensure equal pay for equal work, and end government interference in people’s selection of restrooms.
Thank you for your service to our country,
I created my LiveJournal on June 12, 2001, turned on to the service by slyviolet. In my first post I set an intention of using it to track memoirs and musings, share interesting links, and support the site as an open-source, volunteer-run project. My use has followed this overall tenor, though the style has evolved quite a bit–as has the LiveJournal ecosystem.
In the last fifteen and a half years, I've written 1,429 posts with (I think) at least one in every month during that span. My update cadence was much higher in college than it's been during my professional life, with a significant drop-off in 2010 as I started getting my social media fix through company-internal venues. English-language LiveJournal usage has dropped significantly during the Obama administration, probably due to the rise of Facebook, Twitter, Tumblr, and other "Social Networking 2.0" sites. I stuck around because (a) I already had a decade of content on LiveJournal and (b) the site's design and community supports long-form content, which is sorely absent in today's volume-focused social media landscape.
A faction also started leaving LiveJournal after its acquisition by the Russian firm SUP Media. Dreamwidth launched in 2009 using a fork of the open source LiveJournal code base, a modified subscription/access model, a different terms of service, and no ties to Russia. Dreamwidth attracted a significant slice of the English-language geekery and fan fiction demographic from LiveJournal.
Recent weeks have seen a renewed migration from LiveJournal to Dreamwidth. This post summarizes some of the drivers, in particular the fact that LiveJournal's servers now seem to be physically located in Russia and the contemporary political climate in Russia is somewhat bleak on the free speech front.
To a software engineer like me, the idea of mandating a particular piece of the web reside in a particular country is ridiculous. The whole point of the Internet is that people from anywhere in the world can share data with people anywhere else in the world. TCP packets don't need to show their passport at the border and a connection between New York and Los Angeles could pass through London, Dubai, and Tokyo if that turns out to be the fastest route. Yet as the Internet has grown to be of more political and commercial prominence, several governments have taken a keen interest in the geographic location of stored data. Sometimes these laws (proposed or passed) happen because legislators don't understand new technology, so they legislate computing the way they would legislate paper. Sometimes the laws seemed to be based on a desire to drive infrastructure development in their country: "If we require Brazilian users' data to be stored in Brazil, tech companies will build more data centers in Brazil, which will drive jobs and tax revenue."
If these were the only two reasons to require data geolocation, LJ servers in Russia wouldn't be a big deal, aside from perhaps slower page loads from the U.S. Unfortunately, several countries have passed (or would like to pass) data location laws so that user content can be subject to local jurisdiction. And, if you're cynical, the government might also want the data to be available for a police raid where they grab hard drives from the data center. In the specific case of Russia, having data subject to Russian law may be of concern, as the Duma has recently passed laws restricting free speech in ways that would feel uncomfortable to many folks in the west. I'm not sure that the "cops with guns and USB cables" scenario puts your LJ data at significantly more risk today than five years ago: Russian hackers have been plundering data from around the world for over a decade and the Kremlin could probably exert pressure on SUP employees to reveal data they steward, regardless of where it's stored.
If you're a LiveJournal user and care about your content, I think it's wise to create a Dreamwidth account (free or paid) and back up your entries (it's easy). Even if the Russian government or hackers have no interest in your journal, having a backup of your data puts you in a more robust position if SUP goes out of business or turns out to be unprepared for a technical disaster.
Additionally, LiveJournal seems to have turned off HTTPS encryption: https://www.livejournal.com/ now redirects to http://www.livejournal.com/ and likewise for individual journals. This seems like a pretty suspicious setup in 2017, when anybody and their uncle can get an SSL certificate for free. So you should probably assume that somebody's listening in on your LiveJournal traffic, regardless of what you think Russian actors (or anyone else) might want to do with said data.
Ironically, moving data outside the U.S. may actually make it moderately easier for the NSA to get at it, since they have to invent complex procedures to legally snoop on U.S. citizens' data within the U.S. but have more statutory freedom to raid international data. If you want to keep your writings protected from the five prying eyes of the world's spy agencies, your best bet may be pen and paper. If you want to store it digitally, strong encryption and public-key based individual sharing is a good (though not very user-friendly) approach. The best balance may be a major tech company which has the resources to spend on high-quality security engineers and is willing to spend big bucks fighting court orders to secretly hand over user data. The big corp, even though they have a closer relationship with the government, may stand a better chance of defending your data than a small startup founded on principles of pure privacy.
In August and early September I thought I was doing reasonably well: after losing 20 pounds in two months, my weight had stabilized. No problems were detected with my colonoscopy or EGD. I was figuring out which food textures I could handle and felt good enough to go to Burning Man. In the desert I alternated between rough days (including passing out after building camp in the sun and then having a gin and tonic without enough water) and days where I felt good enough to bike around the Playa and get excited by people's wonderful gifts.
Eating was still a challenge; on our wedding anniversary I felt accomplished because I was able to eat a hamburger and most of the bun and only had to regurgitate once. A couple days later, I started having trouble with foods that had previously been manageable and I spent a game day unable to swallow water for twelve hours. Over two weeks I lost another five pounds and realized the treatment of acid reducers and careful eating was not moving me back towards health.
Hypothesizing that my parasympathetic nervous system or vagus nerve might be compromised, I saw a neurologist in early October. He recommended an MRI, so I spent two hours in a noisy box while the rest of the country was watching Trump and Clinton debate (I think I came out ahead). The MRI didn't detect any neural problems but it did uncover an unusual mass behind my tongue, so the neurologist set up an ENT appointment for me and stressed the urgency of the matter.
My ENT visit featured an endoscopy with a camera tube pushed through my nose and into my throat. This was as uncomfortable as it sounds, and managed to trigger regurgitation of my breakfast smoothie. (I was kind of excited about this: it was the first time I'd managed to demonstrate symptoms in a doctor's office. I assured him that while it wasn't pleasant, I was happy to do all manner of unpleasant actions as long as we could get data from it.) The scope got a better look at the unusual mass and asymmetries in my esophagus, but didn't result in a clear story, other than the fact that it didn't look particularly cancerous.
Wanting a closer look, the ENT called a doctors' huddle and recommended a CT scan. This was a quickie compared to the MRI. Two ENTs looked closely at it and couldn't find anything that would cause a swallowing issue, though they did discover that I have a pair of extra salivary glands. (Maybe that's why I've always done more spitting than the average person.)
On December 7th I had a long-awaited manometry study. The previous couple days had been fairly rough from an eating perspective and I consciously didn't do anything in particular to try to improve my situation, hoping that being in bad shape would improve the chances that we'd learn something during observation. This study involved another data-collecting tube through the nose, followed by swallowing water and apple sauce while lying down. Just getting the tube into my esophagus was a challenge: my esophagus had gotten so sensitive to irritation that it was trying desperately to regurgitate this foreign object. We finally got the tube into place and I laid down, sipping water and then apple sauce while the scope recorded pressure changes along my esophagus. Swallowing with a tube in my throat was very challenging, and I don't think any of the liquids actually entered my stomach; I regurgitated a couple cups worth of goo during the process. After removing the tube, I just sat in a chair for about twenty minutes, trying (and frequently failing) to drink some water, finally succeeding thanks to a peppermint candy and time. The nurse was very supportive and empathetic, but I could tell that this reaction was far from typical.
The original plan had been to get fitted for a 24-hour esophageal pH study after doing the manometry. When I scheduled the procedure, I'd misunderstood the nature of the pH study–I thought it was going to be a wireless probe, but it was another scope, attached to a box. Although the pH tube was smaller than the first one, I reflected that there would be no way for me to eat foods like bread, fruit, and steak which would trigger my problems. Given how unhappy my esophagus was, I would've been lucky to keep down hummus and ice cream.
Last Friday afternoon, I got a call from my gastroenterologist. It was an early Christmas present in the form of a diagnosis! It turns out I have achalasia, which is Greek for "my sphincter doesn't relax." This is basically what I'd been assuming based on the last three months of eating a soft and limited diet and still regurgitating frequently: food goes down the tube but my lower esophageal sphincter doesn't open (or doesn't open very wide), so everything just backs up until it hits a critical level and everything gets kicked out the door it came in.
I was prescribed nifedipine, a calcium channel blocker which is often prescribed for high blood pressure. I've been taking 10 mg before dinner and have seen a marked improvement: I can eat significantly more while sitting for several hours than I could before the drug. Regurgitation can still trigger, particularly with gristly meat. I'm also not back to normal human eating speed: a modest meal begun at 7:30 might finish at 11. I hope this will come in time: my stomach is still adapting to this caloric increase, so the parasympathetic signaling is probably still in "whoa, slow down" mode.
Wikipedia notes that primary achalasia has no known cause, though recent research suggests there's autoimmune involvement, including one patient inventory that found that patients with achalasia were 256 times more likely to have uveitis than the control group. Hey hey, now the beginning of the year and the end of the year are coming together.
In the next two weeks I have appointments scheduled with my gastroenterologist, rheumatologist, and an upper GI surgeon. My current thought is to try the anti-autoimmune drugs first and see if they retard inflammation in the lower esophageal sphincter. This is partly because it would kill two birds with one stone (cutting back on arthritis progression and back pain) and partly because I lost all my energy reserves this year, so I'm worried about my ability to recover from a surgery. I'll see what the experts think, though.
Emotionally, this diagnosis is a big win. It's helping me switch modes from "I my body might slowly wither away and die next year" to "there's a clear path of action to eating like a normal human again." There are still some low points though–I couldn't keep down water on Christmas morning and was in a pretty morbid mood until I was finally able to hydrate in the early afternoon and then work my way through a very soft dinner.
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 next time I saw an owl in Boulder was, IIRC, a little after midnight on November 2nd. I was standing on top of the parking garage after the annual DeVotchKa Halloween show and an owl was hangin' out atop the new condo at 15th and Pearl. Maybe he'd just seen the show, too.
This year, I didn't go to any Halloween concerts. With my troubles eating lately, three hours spent expending calories by dancing and not eating anything has seemed like a risky proposition. But early this evening, as Kelly and I were raking leaves out of the ditch in front of our house, we heard an owl hoot. We looked up to the mostly bare tree across the street and saw the telltale silhouette of an owl perched on the highest branch. Maybe he missed seeing me at the show and wanted to check in on me.
Thanks, owl. It's been a rough year, but I'm hanging in there. I'll make it to next year's show.
One benefit I had not anticipated from wearing a wedding ring every day is that it gives a tactile warning when I'm dehydrated because it's loose and slides around more.
The danger is that when, say, I'm doing yardwork while dehydrated, there's a danger that the ring will slide off my finger into a big bag of dry leaves. Good thing I love playing with leaves.
The Day: Saturday, September 24th.
The Time: Arrive after 2pm, leave when you get tired or think of something better to do
The Place: Lucky Gin
The Phone: 303-EEL-WANG
Bring friends, games, food, kids, drinks, and stories of fun summer adventures!
If you're hoping to have me try the food you bring, note that my diet is still bizarre (and too complex to explain here), but I've been able to eat significantly more foods this week than I could earlier this summer. So bring something tasty, and if I can't eat it, all the more for the rest of you :-) If I time it right, I should be pulling a garden-fresh, egg- and dairy-free zucchini bread from the oven around the start of the event.
See you Saturday!
(Oh gods am I happy to be eating bready substances again. My trial-run zucchini bread was still warm in the oven when we got back from the movies to night. So soft and moist and comforting!)
I can only recommend reading this document if you need help falling asleep, or if you would find it educational to read a seemingly spurious list of components which might be found in a computer system.
That Friday, I had an appointment with my gastroenterologist. When I told her I'd been taking meloxicam for chronic inflammation, she immediately recommended against it, due to negative NSAID interactions with the stomach. I stopped taking it, and was able to eat somewhat normally over the long weekend.
The following Wednesday, July 6th, I got to work and had a plate of scrambled eggs. That too led to several hours of mucus reflux and slow ejection of egg from my stomach and esophagus. Noting that the two commonalities between the vomiting episodes were eggs and Wednesday, I added the former to my growing list of speculative dietary restrictions.
In late July, I had a colonoscopy (all indicators normal) and endoscopy. They dilated my esophagus, which led to three blissful days during which I could eat like my former self. Unfortunately, that Friday I had an acid reflux issue while getting off my bike, then a return to the vomiting and mucus problem, and once more to the constricted esophagus. Bah.
That weekend, I started taking curcumin (turmeric) supplements, recommended by my podiatrist as a non-NSAID anti-inflammatory. During the winter and early spring I'd been consuming a bunch of turmeric by way of chai (not to mention a tamarind-turmeric pie or three), but a crock pot of hot liquids is less enticing during hot weather.
On 8/8 I had a medical hat trick: follow-up visits with the podiatrist, gastroenterologist, and rheumatologist. The latter two cautioned against turmeric as an NSAID replacement, noting that it works on the same pathways as NSAIDS. (It's a COX inhibitor.) So I stopped taking the supplement.
This Wednesday I had another bout of "Your next several hours will be punctuated by ejecting mucus," brought on by a delicious side of cardamom rice. "WTF, am I allergic to Wednesdays?" I wondered. I checked the ingredients today, though, and noticed it had turmeric in it.
All righty then. Add turmeric (and by extension curry) to my dietary restriction list, along with eggs, spicy things, bready things, milk, steak, and anti-inflammatory drugs. And maybe be extra careful on Wednesdays?
This evening, I started wondering: if turmeric is a problem, are there other anti-inflammatory foods I should avoid? I found this nice open access paper on natural anti-inflammatory agents which explained the pathway for several of them. COX inhibitors (NSAIDs and turmeric) can produce stomach problems, particularly when they affect COX-1, which "promotes the production of the natural mucus lining that protects the inner stomach and contributes to reduced acid secretion". Fortunately fish oil isn't a COX inhibitor (it sounds like it gets COX to generate anti-inflammatory prostaglandins which in turn inhibit inflammatory cytokines. There are some herbs which inhibit NF-κB–green tea, maritime pine bark, red wine grapes, cat's claw, and chili peppers. It sounds like NF-κB may inhibit COX-2, not sure about COX-1. (There's also frankincense which inhibits 5-LOX, which I don't yet understand.)
After kinda-grokking all that medical jargon, I had a couple insights.
First, if I pursue a pro-inflammatory diet, would that stimulate my COX-1 response and help rebuild my stomach's mucus and reduce acid issues?
Second, maybe my health focus should be finding the ideal anti- and pro-inflammatory mixture. I've got an inflammatory chronic disease, and too much inflammation leads to serious acute problems. But I think I'm learning some of the ways that inflammation serves a vital role in my health. Fortunately I'm a Taoist; I've got the mental framework to wobble down this path.
At a family reunion for the Minnesota-Norwegian branch of my tree last month, one of my dad's cousin said there was a high incidence of autoimmune disorders in the Peterson family. Yet also, all the great aunts and uncles either died suddenly at 72 or lived into their late 90s, with two or three centenarians. They grew up on a farm and spent their lives eating flour and lard. Maybe I need to work pastries back into my diet. If only I didn't have trouble swallowing bready substances…
The first is an account they created when my friends signed up for Facebook and let it run through their email accounts looking for contacts. They checked a box next to my name, which Facebook took as a signal to create an account for me and periodically send me a message letting me know that I've been invited to their service.
The second account is for my work address. Someone with the same first initial as me who isn't very good at using the Internet created a Facebook account and entered my email address. Facebook sent me a couple messages letting me know I had one more step I needed to complete to start using the service. After a while, they switched modes. That account is in an experiment wherein they email me every day. The subject has the names of three people I might know on Facebook and the body has three more names. The number of names in the subject that I recognize is remarkably high for a big company, so I think the Facebook app on Android uploads your phone's Contacts list (i.e. the people you email occasionally) to Facebook.
I just learned about a third Facebook account I have. I received two emails and a LinkedIn friend request from a Facebook recruiter this morning within the span of one minute. The first email was sent to my personal email account (not the one printed on my résumé) and the address firstname.lastname@example.org. That's pretty clearly a 64-bit integer, which is what a database like Facebook's would use as a user ID. I sent a test message to that address and it wasn't delivered to me, so I don't think it's meant as an alias for delivering mail to me. Maybe mail sent there gets appended to a communication log on my Facebook Job Prospect account.
Some people wonder what Facebook does with all the data about themselves that they give it.
I wonder what Facebook does with all the data about me that I never gave it.
Anyone want to guess how many accounts Facebook has about you?
So as to make maximum use of a clean kitchen and sanitized equipment, we made extra must with the honey and started two 1-gallon batches without any extra ingredients. One (or maybe both) will get violet leaves in the secondary; I'm thinking hawthorn berries for the other, particularly if I harvest more in time this fall.
We've got about 25 lbs left of the Dutch Gold organic Brazilian wildflower honey we got in bulk for the last batch. That's enough for two dry meads; Kelly has plans for a lavender metheglin. ("Metheglin" is, of course, a fancy word for "mead with herbs.")
Also, I think drinking honey is good for my throat :-)
Organizing my thoughts for a gastroenterology appointment on Friday, here's what's been going on with my esophagus and stomach lately.
For all of 2015 (starting either after oral surgery for wisdom teeth or a bad night of vomiting), my main health problem was acid reflux. Sometimes it would cause me to wake up in the middle of the night with heartburn. Other times, it would make it difficult to eat because of acid bubbling up the throat during a meal. I needed to carry ginger candies around in case I got a sudden acidic discomfort while sitting around.
In late January I was diagnosed with psoriatic arthritis, an autoimmune inflammatory condition. I tried a bunch of anti-inflammatory things, including cutting out gluten, drinking lots of home-made chai (largely for the ginger and turmeric), and took occasional meloxicam (an NSAID) when feeling achy. I'd already started feeling better when I got the diagnosis, since I'd had a couple weeks of steroids fixing my acute eye problem, and by mid-February I was feeling fairly good as we left for Hawaii.
I reintroduced a mild amount of gluten in Hawaii, figuring the experience would be more fun if I enjoyed some saimin noodles and a brewery. About half way through the trip, I felt like I was fighting a mild sickness. (When traveling outside the continental U.S., it seems I almost always get sick at the half-way point, no matter how long the trip is.) That night, I had the worst night of acid reflux since the problem began; totally unresponsive to ginger and so intense I didn't sleep all night. Around 3am, I took a famotidine (an H2 antagonist), and took one or two a day for the next three days or so. During that period, the feeling of acid basically went away, though swallowing was often still difficult.
Since returning, I've had almost no acid or heartburn (except, ironically, during a physical exam at the doctor's office). I'm still not sure why it would have come to such a crescendo and then suddenly disappeared. It also seems unlikely that a total of three or five H2-blockers would clear an acid issue for four months. Maybe I picked up a bacterial colony on the Road to Hana, they fought it out with some acid-encouraging bacteria, and the invaders won?
Unfortunately, while the acid reflux has stopped, reflux has still been a recurrent issue. I'll often, usually during a meal, have an overwhelming upwelling of mucus, which I have to eject from my esophagus (in a half-spit, half-vomit maneuver that's no fun but that is no longer frightening). After a big mucus reflux episode, I generally have trouble swallowing new food for an extended period. I even have trouble ingesting water, which generally produces a sensation of overflow (like it can't get out of the esophagus) and quickly triggers a new bout of vomiting. This experience ebbed and waned in intensity and frequency over the last four months. It was particularly bad in mid-June, before, during, and after my trip to the annual Apogea event (possibly made worse by a body adjustment the day before the trip).
On Friday of the event I was hard-pressed to eat something as soft, moist, and easily-chewed as spam. The difficulty drinking water after an episode made me worry that I would get dehydrated, not because I ran around in the heat without paying attention to my body's needs, but because I could not physically consume the bottle of water at my side. I was fortunately able to get some salt and protein from a bag of bean chips. And then a few hours later, I came upon the remains of a potluck in a camp with good music playing. I found that I could eat a slice of apple and then a second one. Eyeing what I thought was cold cut turkey, I grabbed what turned out to be injira (the spongy Ethiopian bread) and man was it fulfilling when I could swallow that set of morsels. Interestingly enough, even though my GI system was largely nonfunctional during the event, my musculoskeletal system was doing great: I had no problem dancing.
A Tough Ill to Swallow
With the acid reflux replaced by mucus reflux, it's a lot easier to tune into the bodily sensations of the problem in a more precise way than "my whole throat is burning and my stomach feels weird." Sometimes it feels like the problem is mostly in my stomach: there's a bunch of goo at the top, so after I've eaten several bites, new food can't come in. But when the major problems subside, I still often have trouble swallowing. I've been eating slowly for the last year (more so than usual), and these days it can take me a few hours to finish a meal. Fortunately, I have a job where I can eat lunch outside for an hour and then take a plate back to my desk and take a bite now and then until I leave, five or six hours later. This slow-food approach makes eating at restaurants difficult, though; particularly if I need to suddenly eject things from my esophagus while half-way through a steak.
A few stimuli seem more likely to induce swallowing issues (dyspepsia). Dry foods, particularly the gluten-free ginger snaps I got to replace my glutenous camping staple peanut butter delivery mechanism. Corn chips and somewhat dry grains sometimes cause an issue as well. Leafy greens, particularly with dressing or oil. There's something pathetic about not being able to eat a small piece of lettuce or kale. Simple meat; I've had to give up multiple times on steak or bunless hamburgers. Spices, and not limited to capsicum. I've had difficulty swallowing everything from fish with wasabi to sausage and seasoned meat to food flavored with peppercorn to chai with cloves.
I haven't started a food journal yet ('cause that's a lot of bookkeeping), so I don't have any multi-day regression analyses yet, but I haven't found any foods which I always have trouble swallowing (except those darn ginger snaps). Someone asked me what foods I can handle; I responded "On a good day, anything. On a bad day, nothing."
A couple indirect theories worth exploring:
• As part of the psoriatic arthritis diagnosis, I learned that my spine has been fusing with calcium. I've noticed that I've got a definite back curve or slouch while standing, and my height has been decreasing slowly over the last several years. Perhaps the curvature is pushing my esophagus into my stomach, or my hardening spine is pushing from behind.
• Kelly has theorized that my vagus nerve, responsible for the heart, lungs, and digestive tract, might be having issues. This theory is strengthened by the fact that I've had a few fainting episodes in the last few years (including one around the time of acid onset), but it needs further exploration with a GI expert.
Bowel Movement and Stagnation