From the Mind of Trevor Stone

Surgery was a success, and recovery has been smoother than I had imagined.

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).

On Wednesday, June 29th, I had a massage in the morning, then ate a boiled egg at work. Around the time I finished the egg, the upwelling of mucus let me know that my stomach was not pleased with the choice. Over several trips to the bathroom, I eliminated that egg. I tried to have lunch over several hours in the afternoon, but ended up vomiting most of that. We went to the ER that evening, 'cause I had nothing better to do, and they didn't see any urgent issues. I was kind of dehydrated, so they gave me two IV bags of saline. The next day was pretty rough, though I was able to eat some non-offensive mung bean porridge and take a nap.

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…

In addition to fresh fruit, Spanish speakers, colorful fabric, ancient stone religious sites, and aquatic marvels Guatemala attracts active travelers with 37 (más o menos) volcanoes. So far I've climbed two, with very different experiences.

Volcán San Pedro is the third highest mountain at Lago Atitlan. Though most hikers start at 6 AM, I thought I'd complain a lot less if we started at 7, and thus was it agreed. Had I realized I'd have a restless night of sleep, waking up regularly due to drunks by the lake, celebratory canon explosions, worry about missing an alarm, and vague awareness of a gorgeous sunset I would've agreed to 6.

With rain gear, water, a camera, and some fruit and bread in our backpacks, a guy met us in front of our hotel (5100 feet) and led us through the quiet Sunday morning streets of San Pedro La Laguna and up the highway to the volcano park entrance (around 6000 feet, if I recall) around 8 AM. There we met our real guide, Pedro de San Pedro. The trail is pretty clear all the way up, but we'd read that hikers are occasionally attacked on the route, so we were glad to accept a guide. Not that he'd overpower an attacker with his machete, but because he knows the locals, which adds a lot more risk to a potential attacker. Pedro didn't seem to understand this role ("I'm not security, the police on the mountain are security" / "What are the police going to do halfway up the mountain?") and several times strayed out of eyesight and later suggested we summit on our own while he rested below. He also made some rude comments while chatting with Molly, but at other times he was an entertaining guy to chat with.

The San Pedro hike is intense, mostly a straight 45° path up the mountain with at least a dozen stair sections. It starts through coffee, corn, and sweet potato fields. After an hour (and a half?) or so we reached the mirador (scenic overlook) and took a rest and pictures of the northeast corner of Lake Atitlan. Pedro assured us that we were allowed to turn around there, but we insisted that we were in for the long haul, even though we walk at a slow pace. We continued through the cloud forest, admiring the bulky mossy trees, trying to spot calling tucans, and breathing hard as our thighs complained about the incline. Around an hour from the summit, we passed some folks heading down who assured us we were a half hour away. Did I mention we hike slowly? We finally summitted -- 9850 feet -- around a quarter to noon and collapsed into a mandarin orange and coconut bread lunch. From the top, we could see most of the picturesque lake, its small towns, its striking mountains, the clouds building in the valley behind the Indian's Nose. Our view further afield was occluded by clouds, the lake's higher volcanoes, and San Pedro's other peak.

After half an hour or so at the top, we headed down the mountain. As a kid, I did a lot of growing up in the mountains, so my Year of the Goat nature gets a big thrill whenever I run down a mountain. With Pedro's steep and sturdy trail, I felt free and safe sailing over roots and whipping around trees. I was also in the odd condition where running was a lot less painful than walking. Yet I didn't want to build up too much momentum, so I'd run for half a minute and then pause for two, meaning Molly's slow walk far outpaced my downhill run. Pedro was getting rather annoyed at his delayed lunch. What kind of mountain guide doesn't carry food and water? We finally reached the base camp at quarter to 3 PM, drinking the rest of our water and massaging our thighs. We caught a pickup back to town and walked gingerly down the steep streets until we found ladies selling jugo de naranja and licuados de piña y mango. MMMM.

So... San Pedro. Listed as 3 hours up, 2.5 down. From our hotel, it was nearly 5 hours up and 2.5 hours down to the base. Total ascent around 4700 feet. Photos: A couple dozen. Legs: extremely sore (full recovery took about five days).

Fast forward past a disappointing "horseback ride" and some gastrointestinal distress to Quetzaltenango, Guatemala's second city. At the beginning of our trip, we ran into Jason, a cool guy who volunteers for Quetzaltrekkers, an all-volunteer hiking organization whose profits go to two charities to help street kids in Xela. He noted they're not in our version of Lonely Planet Guatemala (known affectionately to many as "The Bible") due to a bad experience the author had, but he convinced us the organization was awesome nonetheless, so we tracked them down at Casa Argentina. Although the challenge and beauty of a six day hike from Nebaj to Todos Santos sounded like a great experience, our plane tickets ruled out that option. But what sounded most enticing was a (mostly) full moon hike up Volcán Santa María.

After a casual rainy Wednesday using the Internet for 7 hours, eating curry, kafta, and hummus for dinner, and sitting in on Guatemala trivia night, we met the trekkers at 11 for soup, tea, and bag packing. Their selection of lender gear was impressive, providing several fitting hiking boots so Molly didn't have to wear Chaco sandals in the cold and dark. I was less impressed with my loaner backpack, barely wide enough to fit the sleeping bag, and which seemed intent on placing weight in the middle of my butt cheeks which I'd rather have used solely for walking. (As it turns out, I hadn't adjusted all the relevant straps, and half way up I got a lot more comfortable.) In contrast to Pedro de San Pedro, a local guy who knows the trail and has a machete, the six humorous young international guides (for 15 hikers) carried a first aid kit, three shit kits, three tubs of tasty trail mix, several pounds of banana bread, a tub of hummus, and a big pot for hot drinks at the top.

We rode in the back of a pickup from Xela (7700 feet or so), admiring the freshly cleared sky and lingering rain smell to the start of the trail (8100 feet), met the two dogs who love the hike, and started hiking at 20 to 1. By 2 AM we were finishing the trail mix and enjoying the rest area at 9700 feet. Looking back, we could see city lights and moonlit mountains with small clouds tentatively gathering. The steep section was thankfully full of switchbacks, limiting the angle of ascent and providing regular vistas of the cloud-cloaked valleys below. As we transitioned from bushes to trees around 10500 feet, the fog rolled in. The moon cast a disperse white glow, my headlamp's dim glow pointed out the roots and rocks in the moist trail while white flower petals marked the edge and the occasional firefly blinked in the bushes. For only the second or third time on the trip, I wished I'd brought a tripod. Oh for a 30 second exposure of the moon seeping out from behind a stolid dark tree!

I reached the cloudless rocky summit at about 4:30. Carefully minding my way through cows and their patties (would you climb a volcano if you weighed a ton?), I donned my fleece and jacket and rolled out the sleeping bag to huddle in the dark, wishing I'd brought gloves. Fifteen minutes or so later, the sky started to get interesting, and I decided my fingers were not so cold they couldn't operate a camera. To the northeast, an ocean of clouds blanketed a valley, a mountain becoming an island, a ridge becoming a cloud waterfall splashing into the town of Zunil. To the east was a photogenic sequence of mountains -- nearby peaks framed the mountains around Lake Atitlan, standing coolly in their typical blue haze, while a plume of black smoke identified Volcán Fuego and the mountains of Antigua far in the distance. A few kilometers below us to the west smoked Volcán Santiaguito, its white plume complementing the black triangular shadow cast by our own mountain. To the northwest were patchwork farm fields and green ridges. Somewhere out there in the Cuchumatanes stood Volcán Tajamulco, the highest point in Central America. It was like a view from an airplane, but with crisp cool mountain air and banana bread with hummus.

In addition to the food, first aid and sanitary supplies, the Quetzaltrekker guides had something else in their backpacks: absurd costumes. Complaining loudly as they switched from fleece to sequined spandex, they posed for several absurd vistic photos, indulging in the silliness and camaraderie that comes with three months in an intense volunteer organization. These folks are great.

At 7:20 we headed down the mountain, the dark and looming shapes revealing themselves in the light to be pleasant evergreens and verdant green bushes. The gentile incline meant I didn't feel compelled to run down; a good thing considering the recent rains. We gathered trash on the way down, making the path look more like a backpacker trail and less like a Central American road. By quarter to 11 I was relaxing in the shade, waiting for the chicken bus to take us and our trash bags back to town.

So... Santa María. Billed as about four hours up, with summit before sunrise. I took just a little under four hours up and three and a half down and arrived for the predawn light. Total ascent was 4300 feet. Photos: Over 200. Legs: not sore at all. (Knees were a bit tender for a few hours later that afternoon. No lingering effects the next day. My legs have hurt more after a night of sleep on a budget hotel bed.)

Hiking San Pedro was a good rigorous physical challenge with some nice views and lovely plants. Hiking Santa María was one of the best nights I've ever had, full of tasty food, good people, healthy but not painful exercise, and one of the most amazing views of my life. I highly recommend the hike and I highly recommend Quetzaltrekkers.

From the FAQ at LDS Skinny Dipping Connection:

Question:
How can you be a nudist and respect your Temple garments at the same time?

Answer:
As members of the Church, our commitment to our Temple covenants comes before any other interest - or at least it should. Our garments play an important part in those covenants. As such, Mormon nudists will be more frequently covered than non-Mormon nudists. We are naked any time that it makes sense NOT to be wearing our Temple garments. Swimming is an indisputable time to NOT wear garments, and therefore skinny-dipping is the central naturist activity for our family (and also the impetus for the name of this web site.) Many Church members participate in various athletic activities without their garments (Church basketball, for example) - it would seem equally appropriate to do so in a naturist environment. As members of the Church it is vital that we NOT look for extra opportunities to be separated from our garments. If you don't like to swim or play sports, then your naturist leanings may remain purely mental (or spiritual.) It's an attitude more than an action anyway, and it need not be manifest in any particular activity.

...
Question:
Does "Body-Acceptance" place the flesh above the Spirit?

Answer:
LDS members believe that all humans were literally created in the image of God, possessing a physical body after the pattern of His own. More than most religions, we acknowledge the divine nature of our bodies. No one mortal body should be deemed more or less perfect (or divinely patterned) than that of another person. Physical perfection is not an aspect of our trial on Earth - ALL bodies are mortal and imperfect. Regardless of their conditions or abilities, our bodies are adequate to the task and purpose that our Heavenly Father intends for us. Body-acceptance asserts that fact. Despising our own flesh does not elevate our spirit. Denying the DESIRES of the flesh allows us to be more spiritually minded. Body-acceptance also helps us overcome our natural tendency to covet the physical attributes of another person, or to elevate a person merely because of their physical features. It is based on the idea that the worth of a person's soul is not derived from the body that they were dealt (or have even worked to attain.) Accepting the body we are given, respecting its functions and properties, caring for it wisely (Word of Wisdom, etc.), displaying it only in humility, comporting ourselves with modest behavior - by doing all of this, we become MORE spiritually minded, not less. It's also important to mention that Body-acceptance should never be a euphemism for physical neglect, as that would also come into conflict with the Word of Wisdom.

...
Swimsuits and skimpy clothing create "hot zones" - calling attention to the "forbidden fruits" of the body... When naked, there are no more hot zones - just bodies, with all their parts esteemed equally. The "forbidden" zones are still forbidden from touch - but there is no great mystery made of them. They are simply part of a complete body.

Calling naturism "more an attitude than an action" which "need not be manifest in any particular activity" is a bit like being against "homosexual acts" but not homosexuals. Maybe they're Schrödinger's nudists; they both support and oppose removing their clothes. It just happens to be the case that every time they're observed the probability wave collapses to the second option.

They acknowledge the divine nature of their bodies but believe that denying desires of the flesh (which are, ipso facto, divine desires) is the proper way of spirituality. Nobody said Mormons were the most logically consistent folks, but I think it's great that some people recognize some opportunities to be stark naked in Utah's stark landscape.