flwyd: (rush counterparts album cover)
The last time you heard from my esophagus, dear readers, it was freshly diagnosed with achalasia, a condition wherein the lower esophageal sphincter doesn't relax to let food into the stomach and the esophagus doesn't effectively squeeze to push food down. The result was that food would often build up at the bottom of the esophagus until it reached a critical volume (either from intake or buildup of mucus) and my regurgitation reflex kicked in, ejecting the contents. While the regurgitation was unpleasant, the biggest health problem was weight loss and inability to recover: I'd spend over half the day slowly eating, unable to gain any weight from one week to the next.

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.
flwyd: (Trevor over shoulder double face)
I spent the last three months trying to eat, trying to figure out why I can't eat, and trying to get through life without many calories.

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.
flwyd: (Trevor over shoulder double face)
This is an incomplete post that I started on June 28th. I was going to finish it on the 29th, but ended up going to the ER after a day of vomiting and dehydration. At my GI appointment that Friday, "Stop taking NSAIDs" was the key suggestion and the vomiting issue subsided.

Organizing my thoughts for a gastroenterology appointment on Friday, here's what's been going on with my esophagus and stomach lately.

Non-acid Reflux
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.

This is where the outline continues but details stop, in favor of getting some sleep.

Bowel Movement and Stagnation

Grain proteins

Legal drugs

Inflammation Update

Thursday, May 19th, 2016 12:40 am
flwyd: (intense aztec drummer DNC 2008)
As previously mentioned, I started the year with an autoimmune attack on my eye. This occurred after a month of over-extension: after a long day at work, I'd come home and spend a bunch of energy planning a trip to Australia and New Zealand, then not get a lot of sleep before doing it all again. The first sign of autoimmune inflammation, though I didn't realize it at the time, was soreness in the arch of my right foot. I chalked it up to old orthotics and added new boot inserts to the trip shopping list. I'd also been using a standing desk at work for two months in an attempt to reduce sitting-induced back pain and see if reduced slouching helped my esophagus's acid problem.

My eye recovered fully and my vision is back to 20/15; the only sign of the attack is a small "battle scar" blip on the iris. The only autoimmune blood test that came back positive was HLA-B27. This wasn't too surprising, since it's linked to ankylosing spondylitis, a condition which led to my uncle's fused spine. This antigen marker led to a referral from the eye surgeon to a rheumatologist.

After getting help from my parents to figure out all the causes of death in my family history, the first rheumatology appointment resulted in a diagnosis of psoriatic arthritis (a relative of ankylosing spondylitis), a prescription for meloxicam as needed, an NSAID (similar family ibuprofen, but with longer duration and more powerful per milligram), and instruction to get x-rays of my spine and pelvis. The x-rays showed signs of calcification of my spine and SI joint, so I had another rheumatologist appointment to talk about chronic disease management and treatment options. Basically, my immune system works too well, so it attacks various parts of my body like joints, skin around my scalp, and occasionally my eye. Biologics are the big-gun drugs for autoimmune diseases, which are expensive and increase the likelihood of serious infection. They sound pretty scary, so I decided to focus on "diet and lifestyle" and NSAIDs for a while to see how far I can get with adjusting my environment and routine.

So yeah, that was January. I averaged a health-care office visit every other day, but by the end of the month I wasn't feeling too bad. In February we spent two weeks in Maui, where I was able to do low-impact activities like snorkeling, scuba diving, hiking, mini golfing, and hanging out on the beach. Eating was still a bit of a challenge: the acid reflux and esophageal challenges in swallowing that were my main health problem in 2015 persisted, so there were a lot of rather slow meals. Then, half way through the trip and the day after a hike on the wet side of the island, I started to feel a bit sick, maybe a mild viral or bacterial infection. That night I had a crazy intense acid reflux experience, preventing me from sleeping all night. Around 3:30 I took a famotidine (Pepcid) pill that I'd been prescribed but hadn't really used. Two and a half hours later, we got on the ferry to Moloka'i. With only a few thousand residents, no stoplights, and a laid-back culture, Moloka'i is a great place to feel crappy. I started feeling better, and acid issues started to fade. Remarkably, I've had hardly any acid reflux in the three months since returning, though I've still got some swallowing challenges.

My mom gave me a copy of The Anti-Inflammation Zone by Barry Sears, the creator of the Zone diet. The book explained, to a moderate degree of satisfaction, how pro- and anti-inflammatory responses work (arachidonic acid versus eicosanoids and other long Latin names). Sears's primary recommendations, repeated over and over, are the Zone diet and high-dose, high-purity fish oil for EPA and DHA. I found his discussions of the diet kind of annoying, particularly since his extensive biography wasn't footnoted from the text, so I couldn't tell what was part of the diet plan because of sound science and what was present arbitrarily. The fish oil recommendation, on the other hand, seems to have solid science behind it. I've been taking fish oil for a couple months, currently around 2 teaspoons per day (~3 grams of ω-3 fats), and eating salmon and herring whenever I get the chance. The EPA doesn't seem to have done much for my foot/ankle/SI joint inflammation, but my psoriasis symptoms seem to have improved, perhaps from the DHA. During the winter I was drinking a lot of homemade chai, with the goal of increased intake of the anti-inflammatory ginger and turmeric. I even brewed a tamarind turmeric galangal brown ale. Keeping a crock pot of warm chai has been less appealing as the weather has gotten warmer.

I've been back and forth on the meloxicam. The side effects so far haven't been too bad&endash;mostly mild dehydration from my kidneys working hard–but stomach issues and intestinal bleeding are possible. When I take it for several days, my ankle/foot pain is a lot less, and I think it may help my esophageal troubles. After taking it all last week and experiencing very few choking incidents, I stopped taking it over the weekend. The last two days have featured moderately increased foot pain and some distressingly intense swallowing problems (leading to unpleasant regurgitation), so I'm taking the drug again in the hope that my eating challenge can be addressed by reducing inflammation.

Emotionally and intellectually, I've been adjusting to a lifestyle focused on eliminating stress, reducing voluntary commitments, and enhancing physical health. My natural tendency is to overcommit and prioritize tasks over sleep, exercise, and hygiene. That's a good recipe for accumulating inflammation, so I'm learning to say "no" and prioritize my own health over being helpful all the time. I've also been riding my bike (yay springtime!) and more regular about stretching on the floor and not sitting still for hours, though I've been in basically the same position in my hammock for the last two and a half hours of blogging. The nice thing about chronic illness is that if I don't do things right today, I can get back on target tomorrow.
flwyd: (tell tale heart)
As is often the case, when exciting things are happening they take up most of my time, so I don't blog about them. So what better use of a New Year's Eve at home than a recap of the annum.

My primary foci for 2015 were my wife, my job, and my esophagus.

Wedding

As you may recall, I proposed to Kelly at the Temple at Burning Man 2014. Planning and executing a wedding celebration took about a year, culminating in a wonderful gathering of 150 of our best friends on September 19th. Knowing that we wouldn't be able to pay attention to everyone at a single wedding day event, we created several opportunities to spend time with people: bridal shower, game day, a hike, a storytelling evening, a union ceremony, a reception full of dinner and dance, and a Sunday brunch to recover and say farewell.

Most of the decisions we made turned out really well, in some cases being more key than we'd realized.
  • Planning and conducting the ritual ourselves
  • The yin-yang and I Ching theme and the eight friends and family that played trigram roles
  • The grand-right-and-left movement across the circle that brought guests face-to-smiling-face
  • Foothills Community Park in Boulder as a venue, even though nobody told us there would be six soccer games in the field where we wanted to set up
  • My Mom's Pie in Niwot who made 20 pies to boost everyone's blood sugar after the ceremony; much better than cake
  • The Dickens Opera House in Longmont which were very accommodating, served a great dinner, and had a great space for dancing
  • Double helix rings from Zander's Creations; I didn't expect to enjoy wearing a ring every day, but it's been really nice
  • Reusable wedding outfits; we looked fabulous for a wedding, but we can also wear them on anniversaries and other party occasions
  • Not having an expectation for wedding night sex because we might be exhausted, but being sufficiently energized that we could have fantastic sex anyway
  • A Google Sheets gift suggestion list rather than a specific store's registry; we got a wide variety of gifts that can't all be found in one place (except, now, our house :-)
  • Tracking invites, RSVPs, food restriction, chair requests, and everything else with Google Sheets


I think it's a very good idea to plan a wedding before getting married. You learn a lot about your partner and have an opportunity to get a lot of significant arguments out of the way. If you can get through all the stress and conflict of wedding planning and still want to get married, I think it's a good sign you'll stick together. Along the way, we stressed about
  • What sort of wedding to have
  • When it should be
  • Where it should be
  • How many days it should last
  • How many people should be involved
  • How the ritual should be structured
  • How the reception should run
  • Timelines for invitations
  • Making homebrew in time for the big week
  • Construction of flagpoles
  • How to move humans in lines and circles
  • Who was going to attend, even though they hadn't RSVP'd
  • Where guests would stay
  • What car to take
  • Folding chairs
  • The position of celestial bodies
  • … and probably more I've forgotten

That's all a lot of chaos for a couple of introverts, so we had a separate private commitment ceremony in advance: just Kelly and Trevor and Joan the cat and a marriage license under the blue moon. This was the yin side of the wedding: inward looking and nurturing at night, establishing fortitude before the yang energy of crowds and movement in the sun.

Rest and Recovery

The traditional follow-up to a wedding is a honeymoon. But planning a wedding is a lot of work; planning a long vacation immediately afterwards would add undue stress. Instead, we set the intention of doing little but sleep, eat, and screw for the next month. Around our mensiversary we took a four-day agave moon to Valley View Hot Springs for further relaxation and a side trip to the Colorado Gator Farm and the sand dunes.

Moon of Honey

We'd been talking for some time about a honeymoon in Iceland. Winter isn't our ideal time for adventures near the Arctic Circle, so we figured we'd plan something for the summer time. Fortunately, we got an opportunity for an early summer. I've got a business meeting in Sydney in mid-January, which sounded like a great starting point for a month of adventure in the Southern Hemisphere. Wondering if there were any interesting Burner events in Oz, we discovered that Kiwiburn is the week after my meeting. It turns out that New Zealand has a more compact set of adventure opportunities, fewer things that will kill you, and less intense summers. We're still working out the time balance between former British colonies, but it looks like we'll spend more time near the flightless birds than pouched mammals.

Home

In 2014 we moved in with some friends in Ranger Outpost Cherryvale. Despite good intentions, the arrangement didn't work out. We got a great opportunity on a place we call Lucky Gin, with ample gardening, a nice kitchen, and plenty of space to host friends and family in case a wedding should break out. Providing a safe home was one of my key wedding commitments to Kelly, and we hope to stay here until we have the opportunity to buy a house.

Googling and Alpha Bets

One of my big work accomplishments this year was the full launch of the new Google Drive web UI. I led the handoff of production management and oncall duties to our great site reliability team. I then turned my attention to migrating the invisible and lesser-seen parts of our old and crufty server to smaller, easier to maintain homes. This led to a project of introducing an internal framework suite to our organization, evangelizing its use where appropriate, and coordinating things to make the transition feasible.

After six years on the team and my natural inclination to absorb information, my brain has become a repository for a lot of disparate parts of our system. My day to day work often involves answering lots of questions by email and reviewing lots of design documents. This means I don't spend as much time writing code as I would like, but it does mean that I'm demonstrating impact and scope, so several people have told me I should go for promotion. I declined to spend energy on that process this year because the performance review cycle was the same month as the wedding and I was busy working on my promotion from fiancé to husband. The next performance review cycle starts when we get back from our honeymoon, so it may end up feeling like an unproductive quarter.

The Esophagus is Connected to the Stomach

The least fun part of this year has been my gastrointestinal experience. Around the beginning of the year I had several sudden onrushes of an acid feeling, often expressed as tightness in the chest or pain in the jaw. They would often happen at night, waking me up and making me worry that I had heart trouble. I would also experience sudden trouble eating, finding it difficult to swallow. This was often on the third or fourth bite of a meal, but would also happen if I had a bready snack. Sugars like dark chocolate and dried papaya seemed to keep the issue somewhat at bay, and could provide relief after a sudden acid attack. At first I thought the feeling might be a side effect of wisdom teeth removal, but it became fairly clearly gastrointestinal.

Western medicine didn't do a great job on this one. I saw my primary care physician early in the year. After a suite of tests ruling out heart trouble and a variety of other issues, he prescribed omeprazole (brand name Prilosec), a proton pump inhibitor that helps reduce acid reflux. A course of that takes a while and didn't seem to solve the problem, so a few months later I saw an enterologist. That led to an endoscopy a few weeks later, in late April. That turned up partially elevated levels of an inflammation sign, but was otherwise unremarkable. So they prescribed a stronger dose of omeprazole, tapering over two months. That seemed to help a bit, but not a huge amount. In August I returned to the enterologists, who prescribed a modified barium swallow, which is basically a video X-ray of me eating. Of course the condition didn't end up triggering while the speech pathologist was working with me in the lab, but we determined that there didn't seem to be a structural problem in the throat. As the omeprazole course ended and I still had no better idea of the problem than eight months before, I returned to the entorologists. The next prescription was an inhaled steroid, with the goal of reducing the acid in the throat so it could recover on its own (IIRC). I picked up the prescription, but was wary of taking it, so I paid a visit to the naturopath who diagnosed me with a milk allergy over 20 years ago. As I described my symptoms she immediately inferred the problem: the top of my stomach stuck in my esophagus, likely from a night of intense vomiting last December (one of two likely proximate causes I mentioned on every doctor's visit). Her attempts to pull my stomach out of my esophagus were unsuccessful, though. Finally, I paid a visit to a massage therapist who's worked with my family for years. He was similarly very familiar with this condition and with half an hour of body work got my GI system in the best shape it's been all year. The problem isn't fixed entirely–I still often have trouble swallowing and occasionally get awoken in the middle of the night by an acid shock–but it's a case where a holistic approach was able to both diagnose and mostly solve the problem way faster than the western approach focused on data, hypotheses, and attacking symptoms.

Zymurgy

Aside from marriage, work, food consumption, moving, and gardening, my time has been occupied some this year by brewing. It's a hobby I'd wanted to get into, but had put it off until owning a house so that I didn't have to worry about moving a fermenting 5-gallon carboy. My cider foray in 2014 got me started with equipment and I took the opportunity of a more convenient kitchen at Lucky Gin to get into beer brewing. In the late spring I made a by-the-recipe Belgian wit that's been well received; even some non-beer-drinkers have said they enjoyed it. In the summer I took advantage of the juniper tree and mint patch in our back yard and made a batch of ginger juniper saison. (Intended to be ginger-mint-juniper, the mint is basically undetectable.) This brew has been a hit with homebrewers who've called out the juniper aroma without it being an overpowering taste and the complex flavor profile from the ginger. Finally, Kelly and I started a batch of honeymoon mead this week. We hope to rack it before leaving so the yeast can be cheering us on from the secondary fermentation while we enjoy a more figurative honey.

In the kitchen, I also made at least four good rhubarb pies with our bumper garden crop as well as a couple rounds of banana and zucchini bread. Maybe one of these years I'll master pie crust.

I raise a glass of mead and a slice of pie to my friends and wish you all a happy new year. I'll see you on the flip side, so to speak.
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