From the Mind of Trevor Stone

The past couple months have felt like things were getting back to normal. In March(?) we got to have assigned desks again at work, which meant I could do things like stand on a stress mat, not bike with a laptop every day, leave a box of Altoids on my desk, and see what Chrome tabs I had open on March 11th, 2020. In early April I took a road trip, then met our Canadian coworker in person for a week of team bonding. I'd been reminded that Happy Thursday is a thing I used to do, and made it to three weeks in a row of colorful people riding colorful bikes around town. Eating food in restaurants feels normal. After a chilly spring season, I'm summer season captain for the office softball team, which has been playing pretty well.

On Sunday I climbed around on ladders and garage roofs to help a blind friend get his ham radio antenna re-attached after the big wind storms this winter. I then took my parents out for Mothers' Day dinner. After I got home from dinner I noticed a bit of a scratchy throat, so I took some vitamin C and went to bed at a reasonable hour. I'd been feeling more sore and tired than usual during the previous week, including discomfort lying in bed and being really tired when waking up. This feeling was reminiscent of my state a few years ago before I started taking Humira to tamp down my immune system, so I wondered if the drug wasn't working as well as it used to, or if I'd ended up with a weaker batch. I also reflected that I'd had lots of late nights sitting in a somewhat awkward chair being engrossed in the Internet, so self-induced posture problems were a possible cause.

On Monday I was extra sore and tired when I woke up at about 10:30, so I decided to work (and slack off a bit) at home, given the scratchy throat. I took a fancy Cue home COVID test in the afternoon, which was negative. I worked on some code on the back porch, and finally took the initiative to call the power company about an every-10-second beep that had been annoying for months. I used the last of the light to attempt to get the sprinkler system running again, but didn't have quite the right setup. My arms, particularly the right one, were still sore (I chalked it up to lots of computer mouse use) and my pelvis felt out of shape, but overall not terrible. I took a long bath; it took all my energy to get up and out of the water, but that's usually how I feel when I'm drained enough to need a hot bath. On Tuesday I woke up around 11 with a similar lack of satisfying sleep and lots of sore body parts, so I decided to take another light day from home, including taking part of the afternoon to get the sprinklers working right. Our softball team didn't have any subs available, and I felt good enough to pitch the whole game while wearing a mask. (The tricky bit was positioning my sunglasses so they wouldn't fog up from the mask, but still keep the setting sun at bay.) Wednesday was another day of waking up sore and tired. It took me several hours to get through a bowl of granola, but that sometimes happens if I end up pouring more in, or I hit a patch with a lot of finely-crushed bits. I did some more work-from-porch relaxing and decided that a walk might help me feel better, so I got dressed and headed over to a meeting where we were testing out technology and room arrangement for a hybrid meeting setup. I was wearing a cloth mask, the other participants were wearing N95s, and we were about 10 feet apart. Going in I'd felt pretty confident that I didn't have COVID (see: test from two days before), wasn't contagious (very little coughing), and was probably having an immune overreaction to something. I started questioning the decision during the meeting, though, as I started having some very shallow coughs and was feeling a mild fever. Later on Wednesday night I felt extra drained, requiring a significant fraction of my spoons to empty and load the dishwasher, which I hadn't mustered the energy for in several evenings.

Thursday was the worst day. The week of ache had compounded, I was frustrated that lying in bed hurt and therefore wasn't restful, and I was exhausted. This was clearly not a "short overreaction to a minor virus" experience. I still didn't have much appetite, was coughing more (still shallow), and had approximately no energy. Kelly thought she saw some concerning signs in my mouth, and encouraged me to see a doctor. In 2022 if you feel sick you're not supposed to go physically to the doctor, so I had a telehealth adventure: sticking my tongue out close to the webcam, trying to shine a small ring light on just the right tongue spot, using a butter knife to sample mucus, and grabbing a home thermometer for a quick test. No stethoscope was simulated, and I didn't record my own height and weight to completely virtualize an office visit, though. The doctor hypothesized a bunch of possible illnesses from flu to COVID to strep throat. They had me do a drive-through test at the hospital. COVID testing has progressed to the point that there's now a combined respiratory test where a single nasal swab will produce test results for COVID, influenza, bronchitis, and about a dozen other respiratory illnesses. The strep test gets swabbed in a different hole, but also gets cultured for a whole raft of possibilities.

Late in the evening my email told me to check my medical portal, where I learned I'd tested positive for coronavirus. D'oh. I quickly emailed the folks I'd met with on Wednesday with profuse apologies and warnings. I emailed next week's planned house guests and recommended that they seek other accommodation. I texted my radio friend a warning. I called my parents. I emailed my softball team and texted the other team's captain. I emailed the coworkers who sit near me. I filled out a "Report Covid" form at work which had a bunch of questions like "What are your symptoms" and "Have you been in close contact with someone who has tested positive" which should be unnecessary if I could start the form with "I tested positive for COVID, tell anyone who badged in to my floor about it." Wow is it a lot of work to do your own contract tracing, it's a good thing I didn't have the "can barely get out of bed" flavor of COVID.

While pursuing responsible disclosure, I opened the Colorado Exposure Notifications app on my phone to figure out how to report a positive test there. I was greeted with a big button asking me if I wanted to enable exposure notifications, and that doing so would require Bluetooth. "Um, yes, please, what in the world have you been doing this whole time?" was roughly my reaction. I'm pretty sure I installed this app in 2020, turned it on, and assumed it would quietly do its thing. I took not having received an exposure notification so far as a sign that my mostly-isolated life over the last two years had meant no close contacts with anyone who tested positive. I hadn't considered the alternative theory that the app had quietly turned itself off (maybe when the phone was in Airplane mode, or after an OS upgrade?) who knows how long ago. I don't recall seeing any "Exposure notifications are turned off" system notifications. This felt like a smoke alarm which doesn't beep when the batteries run low. YOU HAD ONE JOB! I also did another Cue home test, which came back positive. It's encouraging that it detects it (the virus hasn't evolved to evade detection), and an important data point that it might take a couple days of feeling lousy before the test is accurate.

On Friday I woke up to a call from a medical assistant at my doctor's office who said the doctor could send a prescription for Paxlovid, an antiviral medication for COVID. (I haven't been closely following the coronavirus news for awhile, so I was unaware that such a treatment was now available.) They said they could send it to CVS Pharmacy inside Target, an establishment I'm familiar because, for reasons of opaque employer insurance pricing, is where I get my "specialty" medication, even though all the rest of my prescriptions go through the pharmacy at my local King Soopers. I've speculated that this arrangement might be because it was such a pain in the ass to get the prescription set up with CVS Speciality that maybe someone saves money from people giving up and not ordering their specialty drugs. I called their phone system in the early afternoon, giving "Prescription status" to the automated voice system. It asked me for the prescription number which of course I didn't have because I am calling to find out whether you received the prescription. When I convinced the AI that I didn't know the prescription number, it attempted to transfer me to the pharmacy, which was closed for lunch. After lunch I called back twice; the first time "Prescription status" got interpreted as "Covid masks" and without asking for confirmation started to explain that the store sold those. I hung up and tried again, this time "Check prescription status" somehow became "Covid vaccinations" and it transferred me to a recording about how to schedule a vaccination. I called my doctor's office instead, which at least has a recording of a human reading numbers you can press. I reached someone who said they only saw the King Soopers entry in my records as a pharmacy. I explained that I didn't care what pharmacy filled this prescription, I just wanted to know if it had been sent and where it had gone. They called me back shortly and said it was sent to CVS. I called CVS back and hoped that pressing 0 would put me in the queue for talking to a human being physically present in the same place as my drugs. After 15 minutes on the same automated message cycle, including a point when the recording drops out for a few seconds, giving you false hope that someone's actually answering the phone, I asked if any of my teammates were at work this afternoon and could they do me a favor. I armed my manager with my date of birth and got him to walk next door to the pharmacy in Target and check if they'd received the prescription. After a couple minutes of confusion they realized that for a freshly-received prescription they needed to check a different computer system, where it had in fact been received. My manager told me it would be filled in about 25 minutes. I was still in hold message limbo, 50 minutes after starting the call. Not sure what I would've done if I didn't have allies within walking distance of the pharmacy. The "You're not allowed to pick up your medication yourself" challenge builds on the "When you're sick you shouldn't go to the doctor's office" wrinkle from the 2020s expansion pack.

Ironically, after spending all afternoon trying to make sure I could get my hands on Paxlovid before the pharmacy closed and the "Start taking within 5 days of symptoms" window expired I was actually feeling fairly good, way better than Thursday when I'd made the doctor's appointment. (Hail to the vaccines that gave my immune system practice last year.) Another coworker dropped off the medication, my dad brought over a grocery delivery of coconut water, soup, ginger beer, orange juice, and grapefruit (you can tell we're in a mindset). I'm celebrating the fact that I haven't lost any sense of taste by eating kim chi and chocolate fudge brownie ice cream. Kelly and I live in a house where we can easily avoid direct contact, each getting a bedroom, living room, and bathroom to ourselves. All in all, things could be a lot worse.

A couple weeks ago I had a really stick neck, tightness in my jaw, and pain in my ear. I'm certain that all three of these were related, but I'm not sure which was causative. I'd spent a long weekend in a hot spring at the end of April, and my right ear had felt like it had water in it for a while after that, so I figured that might be involved.

After a difficult day at work due to on-and-off headaches due to the ear pain, I put hydrogen peroxide - urea drops in my ears and irrigated with a bulb. This had been the prescription 5ish years ago when I had some persistent ringing in my ears and an overabundance of earwax flushed out by a PA at my doctor's office. It had also worked wonders on my trip to California in February when my ears felt clogged, the pressure changes on the plane were intense, and I had trouble focusing in an all-day meeting because of headaches coming and going and noticeable tightness in my neck muscles.

The drops and irrigation seemed to help for a couple days, then two weeks ago Friday the dull headache quickly shifted into a "You will devote almost all of your attention to the sharp pain in the left side of your head." My task on Friday is reading interview packets and then participating in hiring committee. After struggling through the first packet I realized that there was no way I would be able to make it through another four hours of reading and talking with this level of pain, so I called my doctor's office and asked the meeting coordinator to hand off my other packets.

At the doctor's office, I rated my pain an 8 out of 10. An NP inspected my ears and irrigated with a fancy bottle and warm water, which was more effective than the bulb dropper. A rather large chunk of goo came out of my left ear, and after sitting still for a moment to readjust my balance I felt major relief, right back down to a 2 or so on the pain scale. She recommended using the hydrogen peroxide drops for 3–5 days to get residual wax out and I biked home. I felt so good when I got home that I messaged the coordinator and said "Hey, I can read again, can you give me a packet back?" In my history of injury and illness It's very rare that a treatment takes effect that immediately; even the morphine I got when I broke my arm took longer to kick in, and didn't dial things down that far.

The next day I had another intense ear headache after several hours playing Magic and sadly opted not to go out to see Godspeed You Black Emperor!, since the artful amplified distortion of post-rock didn't seem like a great idea when your ears already hurt. Back home to lie in bed with peroxide making popping sounds as it combats wax.

I didn't have any more sharp pain, but over the next several days my ears felt pretty clogged. At first I figured this was residual ear wax, but fingers and Q-tips weren't pulling much wax out. I have the perk of being married to an NP; Kelly looked in my ears with her otoscope and noted that she couldn't see my ear drums, but everything looked pretty inflamed. I called the doctor's office and got in to see another NP who confirmed that it didn't look like wax, but wasn't sure just what to do. Hypothesizing that it was bacterial, she prescribed ciprofloxacin drops in each ear twice a day (possibly to be combined with Flonaze to combat inflammation), then come back for another irrigation.

Cipro ear drops are apparently an infrequently used medicine. My usual King Soopers pharmacy didn't have any, and sent me to the Louisville location. After a day of taking the drops I realized there were only 14 dropperettes in the package, which only covers half a week for two ears twice a day. I called the pharmacy to get a refill, which led to a multi-hour adventure wherein I learned (a) the insurance company didn't want to authorize it, because the refill date was for after a week and (b) I'd apparently gotten the only box of this medicine at any King Soopers in the Denver area. Oh, and hey, it's Memorial Day weekend, so good luck ordering anything. Fortunately, these are solvable problems. I think the pharmacist was able to convince the insurance company that I'd only received a half-week dose (since apparently people usually only get an infection in one ear). The on-call doctor called in a "Yeah, totally get more of that" prescription, too. (And apparently King Soopers had a coupon that would've made the drug cheaper than going through insurance, if they'd had any in stock.) After a couple calls I found a Wallgreens that had a box in stock and they were able to transfer the prescription from King Soopers.

Ordinarily I would take the position "I'll just skip this drug on Memorial Day and get it sorted out on Tuesday and it doesn't seem to be making that big of a difference anyway." But stopping an antibiotic half-way through isn't usually a good idea, and "a colony of drug-resistant bacteria in your ears" is not an attractive idea when you've just spent two weeks having aural discomfort.

Through Memorial Day, I'd generally had one ear or the other clear enough to hear conversations accurately, though I didn't have great spatial localization and I could tell I wasn't getting the full spectrum from music. Starting Tuesday, both ears felt very clogged almost all of the time; I could have a conversation, but only if I positioned myself strategically and the other person spoke up. Assuming that this was just buildup of ear drops and inflammation residue, I eagerly awaited my followup appointment for irrigation.

On Thursday, the NP looked in my ears again and pulled out a black chunk and inspected it. She concluded that it wasn't ear wax and that the antibiotic treatment hadn't solved the problem, so I should go see an ENT. I called around and found that there was an appointment early (for me) on Friday morning, as luck would have it.

I set my alarm the night before, but it didn't go off because I'd set up my clock off by 12 hours when I moved in. Oops. Fortunately, Kelly gets up early for work anyway, so she asked me "When's your appointment again?" early enough that I could do the morning gig and get to the appointment.

I really should've headed to the ENT rather than my primary care office after the first round of treatment didn't solve the whole problem. They've got a whole bunch of fancy ear tools, including long tweezers that go through the otoscope and a device that amounts to an ear vacuum. She quickly concluded that the big black hunks of goo in my ears were fungal, which clearly explains the ineffectiveness of my week of antibiotics. After removing large chunks she sprayed white antifungal powder in my ears and told me to keep them dry. Now that's something I've never had before :-)

I asked if my psoriatic arthritis might have played a role in this ear inflammation and debris buildup. The PA said that psoriasis can lead to ear issues, but that my case didn't look related. That's definitely a relief, because I was really not looking forward to my ears pulling my neck and screaming at my brain as a chronic condition.

So for the last day and a half, my left ear has been refreshingly clear and able to hear while my right ear has been ringing (though not as loudly as it was) and has reduced hearing capacity but gracefully no pain. My neck, shoulders, and jaw have also been refreshingly loose today. I've got a followup on Wednesday before I head to Apogaea where the PA will clean up the antifungal powder and take another look. Hopefully this ringing is just a little more debris stuck to the drum.

It's my body's half birthday and my new swallowing mechanism is five weeks old. Sounds like a good time to check in. If you're just tuning in, I had surgery in February to address achalasia.

As previously reported, I took the week of surgery off from work. This was a really good move: even though I was feeling a lot better than I'd expected (and my work basically involves reading words on a computer screen, typing, and occasionally talking to people), the dedication to resting and relaxing really helped my mind reset, my energy rebound, and focus on readjusting to food.

I spent the second week working from home, which was also a smart move. I was still on a liquids-and-purées diet which was made much easier by having a refrigerator and a fancy blender fifteen feet from my desk. My dad brought over a big ring of red Jello (a food with strong Stone family associations), Lucky's Market recently started carrying nice cashew yogurts, and I had several bunches of bananas with staged ripeness. I noticed that I pretty quickly transitioned back into "Wait, there's one more thing I should do" mode while working, but since I'd handed off a lot of responsibilities, the number of just-one-more-things was fairly low.

A week and a half after surgery I drove back down to the hospital for another x-ray barium swallow to see how thing were going down. After about two swallows of barium liquid the lab tech got a worried look on his face and called a doctor in to look at the images and compare them to what they saw the previous month. After conferring and calling my surgeon's office, they announced that the study was done and I could leave. Not particularly reassuring…

I had a "review the barium study" appointment scheduled with the surgeon two hours later, so I hit up the army surplus store between the hospital and his office. While trying on a pair of nice "tactical trousers" the hospital called and asked me to return (also not very reassuring…). My surgeon showed me the imagery sequence and pointed to a pattern of liquid spreading that looked like it could be a leak. He was suspicious of this interpretation, though, because I didn't show any signs (like total misery) of having been eating with a perforated esophagus, stomach, or junction for ten days. He had me lie down for a regular x-ray and then conferred with the folks from the barium swallow. After a few minutes he came over and said "What I thought was a leak and what they thought as a leak were two different parts of the image." The additional x-ray and mutual second opinions ruled out leaks in both cases. Thank goodness for questioning data and interpretation.

The recommended diet progression is soft food for the third and fourth weeks. I returned to work since I knew I could depend on tuna salad, egg salad, and hummus in the daily lunch salad/sandwich bar and soggy Cheerios (working up to granola) for breakfast. These were my work-food staples for the second half of last year, so I was confident I'd be able to handle them. I was also very excited to reintroduce things like moist grains (rice, barley, oats, and friends), noodles, berries, and tofu. In week four I made three peanut butter, tofu, and chocolate pies for our office's π Day celebration. The puréed legume goo was a little challenging for my swallowing skills, but not problematic. I was also able to eat several folks' apple pie filling and even some flaky crust. I was able to survive some corned beef, potatoes, mustard, and lamb stew on St. Patrick's Day, though I had a regurgitation episode and concluded that was a little too ambitious.

By the recommended diet progression, I should be more or less back to a normal diet. I'm still eating slower than a normal person, but I can now finish most or all of a large lunch in an hour, which is 80% faster than I could handle a medium plate four months ago. I can get through about 75% of a meal at a restaurant before taking home a box. Spices, dry fish, and little bits that slip through without chewing are still challenging and have led to a few regurgitation episodes, but I'm able to respond to most issues by just pausing a meal and walking around. I've been fairly shy about meat that hasn't been soaked in soup, but I was able to handle ground beef today. I think I'll wait at least another week for meat that I have to cut, but I'll be trying sausage in a day or two.

I've had several intense reflux bouts, usually about half way through the night, though yesterday featured an extended before-bed adventure with mild heartburn. Combinations of Altoids, crystalized ginger, and water only sometimes help settle symptoms. When planning surgery I was aware that a significant fraction of folks experience ongoing heartburn and acid reflux. Having spent 2015 dealing with painful reflux and 2016 dealing with regurgitation and weight loss, I'd decided that I'd gladly trade the latter for the former. I need to get better at building up sleep reserves, though, 'cause I can lose an hour to three of sleep from heartburn without advanced warning.

This month I switched projects at work (still under the umbrella of Drive). We're in the "Figure out what the heck our users really need" phase which means our engineering pace is fairly relaxed and we spend a lot of time reading and theorizing, which has been helpful in continuing my "avoid stress" plan. Unfortunately, I've easily fallen back into the habit of going to bed at 1am, so I'm not making many deposits in the sleep bank, despite not needing to take a lot of withdrawals.

I've still got a "eat as many calories as you can" mindset, but I thankfully don't have to micro-optimize my decisions around it. I'm finally back to having alternating phases of hunger and meals rather than a continuous stream of slow eating and reduced metabolism. I've got way more energy than I did during the second half of last year and I don't feel like I'm in survival mode. I was able to quickly get my weight back to the low 120s but haven't been able to make progress beyond that. I guess my normal metabolism—which has basically been at late-teenager levels for twenty years—has returned. I've abandoned my "eat a pint of ice cream for dessert" weight gain plan, since it seemed to be more effective at triggering heartburn than fat storage. Maybe I should try increasing my beer intake :-)

With all the tests and specialists visits last year, I accumulated quite the list of diseases and ailments that I don't have. I can now happily add Chagas disease to The List, which is pretty comforting because "your esophagus is a little too big to squeeze things" is hard enough on its own without "… and your heart might get too big to squeeze blood, too."

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.

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…

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.

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.

How does a pirate greet you in Spanish?

¡Buenos tarrrrrrdes!

I don´t think I could live in the jungle. The foliage is nice, though it´s kind of oppressive when folks burn it. I could get used to the bugs -- sleeping in a hammock surrounded by a mosquito net is a fun way to listen to howler monkeys. But I just feel so lethargic in the humid heat, where I sweat just by sitting around.

But even with the oppressive heat of the jungle, Tikal is awesome. We hitched a ride there in a pickup; the driver didn´t accept any payment for the trip. We ate coconuts and watermellon and hung out in hammocks in the heat of the day until 4 o´clock, when tickets are stamped for the next day. We got great light and blue skies for photos of ruins. We climbed Templo IV and watched colorful birds chase each other above the canopy. Three guards with shotguns stood by as we ducked under the scaffolding and around to the west side to watch a gorgeous orange sun sink into the arbol green sea. We listened to the jungle come alive as we walked out in the dusk. We awoke to the calls of birds and explored the other side of the park. We met an old Mayan park employee who said he´d just done a ceremony in the ancient palace. He said he wasn´t a shaman, but a trabajador de la luz -- a worker of the light. He was also kind of a creepy old man. We watched French tour groups come and go; we climbed a tall ladder to sit atop Templo V and see the rocks peek above the trees. We paid Q15 for a gatorade, but on the whole we got a pretty good deal for a world famous ancient city.

Meanwhile, everyone seems to have gotten their panties in a wad about swine flu. There are a lot of ways to get unpleasantly sick in the jungle, so I don´t think I´ll expend energy hyperventalating about one in particular. I´m sweating just sitting in an Internet café, so I don´t think I´ll sweat about flu in particular.

I and two other people list low-tech solutions as an interest. I periodically try to think of a good example to explain this interest, but usually draw a blank. But late last week my cat developed a urinary tract infection. I took him to the vet, who prescribed antibiotics. The last time Smoochie took antibiotics, it took five minutes of struggle to get half a dropper of bubble-gum flavored liquid into his mouth and half all over his face. With that in mind, I requested pills to try something new. Saturday night, it took a struggle to force a gravy-coated pill into his mouth. After a few tries, he swallowed it.

Enter my new favorite low-tech solution: Pill Pockets. It's a cat (or dog) treat open on one side. It's easy to slip a pill in, and if it's small you can mould the treat over the pill. Then set the treat in front of the sick cat. He'll sniff it once and eat it without thought. Brilliant and well worth the $11 I spent.

Some people like to see how much alcohol they can drink before they pass out. Tonight I'd like to see how much lemon juice I can drink until I feel better. Good thing we got two quarts at Costco a while ago.