flwyd: (Trevor shadow self portrait)
I've been weighing myself a couple times a day for seven months. The first three months feature a slow decline as I would have days where I couldn't get enough food in my body and was then unable to recover. Then there was a rise as I had a drug that let me eat food (and also triggered water retention). Then a drop after surgery and I was on a liquid diet, then a rapid rise as I started eating like a normal person, then a plateau at what appears to be a new stable weight, though it's 10 lbs lighter than I used to be.

One thing worth noting is how noisy the numbers are: my weight before urinating at night is often 2 lbs higher than my weight the next morning after urinating. There are also several periods where I'm up a couple pounds for a few days and down a couple pounds for a few days as my body retains or excretes water and waste. The upshot of this is that the number on the scale is an overly precise measure of a person's general weight, especially if they're wearing clothes—my weight at a doctor's office was often five pounds higher than when I was naked at home in the morning. If you're weighing yourself hoping for a psychological result (you want the number to be high or low), you can cheat a little by timing when you step on the scale. If you just want to know how much you weigh, just round to the nearest 5 lbs and don't worry about weighing in more than once a week.
flwyd: (spam lite)
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 :-)
flwyd: (Trevor over shoulder double face)
Surgery was a success, and recovery has been smoother than I had imagined.

On Monday, I had a laparoscopic Heller myotomy and fundoplication. It was performed at Swedish Medical Center in Englewood by Dr. Reginald Bell, Nurse Practitioner Kate Freeman, and an anesthetist whose name I very quickly forgot.

My almost eery sense of calm about the surgery continued on the day of the procedure. I think scheduling it for noon rather than 10am helped a lot. I was really relaxed and upbeat in pre-op and got to hang out with my wife and our friend Michelle–who happens to be a hospital chaplain–for at least an hour. We also had a great conversation with Deb, the nursing liaison. Michelle said this position was created for Deb, and I think it's a model which should be adopted widely: she acts as the point of contact for family members, providing patient status and helping the family navigate the hospital and recovery process. She overheard my wife calling my dad to ask him to pick up my prescription in Boulder before the pharmacy closed but after we got home (since he'd need my ID); Deb made a couple calls and got the prescription sent to the Walgreens across the street from the hospital so we didn't have to race the clock.

I would love to provide a fascinating narrative about the experience of having my torso inflated like a balloon and tools cutting my lower esophageal sphincter, relocating my stomach (I had a 3cm hiatal hernia), and wrapping it around my esophagus. (Un)fortunately, very quickly after I was wheeled into the super-bright operating room and I shifted onto the operating table, the anesthesiology drugs kicked in and my next memory is grogginess in post-op.

My "wake up, the anesthesia is wearing off" progress was counterbalanced by hydromorphone for pain relief, so I kept closing my eyes and trying to sleep in recovery. But the act of falling asleep would cause my breathing to get shallower and the pulseox would trigger a noisy desat alarm, pulling me out of sleep. This process went on for an hour or two–taking deep breaths was hard because I had new stitches in my diaphragm–until the drugs wore off enough that I was fully conscious and just in dull pain. I spent another hour or so working up to walking around the floor and drinking water, though a few sips of a protein shake proved too adventurous.

Concerned about the breathing danger posed by the opiates, I only took acetaminophen (Tylenol) for pain. I'd been expecting the pain to be both sharper and stronger; instead, it was more of a big ache. I also hadn't expected my shoulders to hurt significantly more than my abdomen (where the incisions were) or chest (where the esophageal operation took place). The shoulder pain was apparently partly from laparoscopic gas but mostly because of the diaphragm stitches. I had not previously realized the connection between shoulders and diaphragm, but I think it may explain some of my recurrent issues. I'll need to notice their relation in the future.

I had the presence of mind to pee right before the procedure. Through post-op and several hours at home I wasn't able to urinate, despite having gained 7 pounds of liquid that day. After my third bout of trying different positions on the toilet produced no results, I decided to try taking a shower, since I often reflexively open my bladder when immersed in water, even if I just peed. To my surprise, I didn't even have to turn on the water: stepping on the wet floor of the shower was enough to remind my nervous system how to let go.

The first night of sleep was a challenge. I find it difficult to fall asleep on my back, so I spend most sleep time on my side, which is a big challenge with painful shoulders. Five seconds after lying down, I could tell that my bed was not going to be conducive to sleep. I set up some thick pillows on the arm of a couch so my head could be significantly elevated and laid on my back with a pulseox on my finger. My wife curled up on the other couch and asked my oxygen levels when she'd hear me rustling around. She's so sweet.

Other than being tired, having sore shoulders, and a very raspy voice, I felt really good on Tuesday. I had wisely planned to take the rest of the week off work and set no goals for the week beyond resting, hydrating, and reading books. I spent the day sitting on the couch, reading about public discourse and drinking water and vegan protein shakes. The recommended diet progression is two weeks of liquids, two weeks of soft foods, and then careful reintroduction of more challenging items to swallow. This week I've progressed from coconut water and nutritional supplements through apple sauce, gelatin, fruit smoothies, yogurt, creamy soup (think split pea), and ice cream. I think I need to cut back on sugar content, not because it'll make me fat (that's what I'm hoping for), but because my mouth feels pretty overwhelmed. After ⅔ of a pint of vanilla coconut ice cream last night and a probiotic, my stomach was feeling pretty queasy and I woke up with some really intense heartburn and liquid stool at 5:30, so I think I'll back off on the pint-a-day-for-weight-gain plan I concocted last fall.

After leaving the hospital, the pain was never enough that I wanted to take an opiate. I took Tylenol for less than three days, and a COX-2 inhibitor took care of aches for the rest of the week. My body hurts less a week after surgery than it has many times after a week sitting at a desk. With luck, this spring will feature fewer pharmaceuticals than any season since the early autumn of 2014.

My accumulated vacation time is usually focused on travel and adventure, so since I started working professionally I haven't really spent a week just relaxing at home, except when I'm sick enough that my brain doesn't work well. Spending several days in a row casually eating, reading, thinking, and listening to music brings back a sense of what I really enjoyed in college. I should do this six-day-weekend thing more often :-) I also had a really relaxing craniosacral massage on Friday which put my perisympathetic nervous system in a state conducive to some really good sex, so hopefully my libido will recover in tandem with my GI system.

While my body feels really good (the major shoulder pain only lasted about three days and my abdomen is only mildly tender), I'm planning to work from home for the next week so I can have a high-powered blender and a fridge full of low-viscosity foods handy. (A career as a software engineer and an employer who believes in flexible working conditions have been crucial to my ability to handle this disease.) My intolerance to dairy products would've made this adventure difficult two decades ago, but I've been able to find cashew yogurt, garbanzo pesto, and soy sour cream, and coconut/tapioca cream cheese cream, adding to hummus and guacamole in my "condiments I can eat with a spoon" repertoire. Between soy, almond, hemp, macadamia, coconut, and oat, I've also got a tasty variety of liquid milk alternatives.

I occasionally walk past a bag of crunchy snacks and instinctively start to grab for a cracker or something. We loaded up on frozen fish yesterday and I'm excited about my office diet plan next week of soggy Cheerios, tuna fish, egg salad, and canned peaches. I'm not craving solid food so much as I am excited about it, as though I'll be embarking in a week on a long-planned trip to a regular vacation spot: at once familiar and novel.

Thanks to everyone who sent me well wishes and offered to help. Not bringing me food and inserting themselves into my healing process turned out to be the best assistance folks provided. My mother-in-law's delivery of soup turned out to be somewhat stressful (mostly for my wife) and not particularly helpful (since I'd already collected weeks worth of liquids).
flwyd: (copán ruinas stone face)
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."
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.

My Weird Diet

Monday, November 14th, 2016 12:35 am
flwyd: (spam lite)
I sent the following message to folks who are coming to Thanksgiving to (attempt to) let them know what I can and can't eat. This is the first time I've written this all down, so it seems worth documenting for posterity. Hopefully I won't have to refer people to it for too many more months.

Most importantly: I don't have to eat every dish you bring! Feel free to make something delicious even if I won't be able to have it. There will be enough food on the table that I can eat.

Executive summary: texture and thickness are key; spices are limited; strong acids are suspect; fats, sugars, and salts are fine. The simple version is "No dairy, no eggs, no to most spices; either very soft or very crunchy."

The details follow. I realize this is long; feel free to send me a recipe and let me call out anything that will cause me trouble.

The most probable explanation for my eating challenges is that the sphincter at the bottom of my esophagus has trouble opening. This manifests in food restrictions based more on consistency and texture than on ingredients. For instance, I can drink a smoothie with blended peanuts, wheat germ, and barley malt but I have trouble with peanut butter on bread.

The texture spectrum:
  • SAFE: Foods that can be sucked through a straw (broth, smoothies…)
  • SAFE: Foods that dissolve in your mouth or otherwise can be eaten without teeth (ice cream, banana, pumpkin puree, mashed potatoes, hummus, halva…)
  • SAFE: Soft blocks of protein (lunch meat, ham, tofu…)
  • SAFE: Firm foods that chew into small pieces (nuts, carrots, some chips and crackers…)
  • PRETTY SAFE: Foods softened in water (boiled or canned vegetables, noodles, cooked legumes, cooked grains…)
  • POTENTIALLY DANGEROUS: Soft but sticky foods (bready substances, nut butter, french fries, lettuce…)
  • DANGEROUS: Foods with gristle or fibrous bits that are difficult to fully masticate (steak, ground beef, kale, spaghetti squash, many fresh vegetables…)

Additionally, there are some ingredients which my body has painfully rejected in the past few months and I now avoid. Aside from dairy, most of these are foods I've loved eating regularly over the last twenty years, so I really hope I can eat them again by next Thanksgiving.

Individual sensitivities:
  • Dairy (milk, cheese, cream, butter… anything derived from a mammal's udders)
  • Eggs (this prohibition adds a lot of challenge to my diet)
  • Extra-virgin olive oil
  • Red wine
  • Capsicum peppers (both spicy and bell)
  • Peppercorn/black pepper (basically anything with the word "pepper" in it)
  • Turmeric
  • Dill
  • Lemongrass
  • Clove

Since several spices have led me to have absolutely miserable days, I'm taking a very cautious approach to spice. I'm able to handle cinnamon, cumin, ginger, and garlic. If a product lists "spices" as an ingredient, I don't eat it. For individual herbs and spices not explicitly listed I decide on a case-by-case basis. If there's a spice you'd really like to bring to Thanksgiving (particularly in the savory category), let me know and I can do a trial in advance–I'd love to collect some more data.

I'm also taking a cautious approach to highly acidic foods like tomatoes, many fresh fruits, and alcohol. I might accept these if offered or I might decline.

Fat, sugar, and salt are all good. I'm currently dramatically underweight, so the standard dietary advice given to Americans doesn't apply to me–I'm finishing a whole pint of non-dairy ice cream as I write this and I eat plenty of bacon. I can eat plenty of fat as long as it doesn't make food stick to the throat like salad with dressing (and as long as it's not butter). High sugar is fine too; my morning smoothies feature honey, molasses, or syrup. My dietitian also recommended I have 50% more sodium than the max recommended level, so salt is fine. (I'm currently trying to keep dietary fiber low, but I don't worry much about fiber content at social events, so don't sweat it.)

Common food restrictions:
Other than dairy and eggs, I seem to be okay with all the common allergens (nuts, legumes, gluten, soy, shellfish…). I don't follow any preparation-based restrictions (kosher, halal, raw, fair trade…). For the most part, if I can easily swallow it then I want its calories in my belly.

Dietary advice:
I know you mean well, but whatever diet or food you've heard is good for something or other is probably not applicable to me. Most diets have weight loss as a goal, but losing more weight would significantly compromise my health. It's hard to sell diet books if weight gain is a side effect, so if you've heard of a diet, it's probably not right for me (unless you've got a good recipe for chanko nabe). Similarly, I'm actually trying to avoid anti-inflammatory foods for a while. When I was diagnosed with an autoimmune disorder I went full haul on anti-inflammatories. Unfortunately, I think the COX-blocking effects may have negatively impacted my gut, so I cut them out of my diet (with the exception of omega-3 fatty acids and ginger). If you saw an article about some wonder food or supplement, I'm probably avoiding it.
flwyd: (pentacle disc)

One benefit I had not anticipated from wearing a wedding ring every day is that it gives a tactile warning when I'm dehydrated because it's loose and slides around more.

The danger is that when, say, I'm doing yardwork while dehydrated, there's a danger that the ring will slide off my finger into a big bag of dry leaves.  Good thing I love playing with leaves.

flwyd: (cthulhufruit citrus cephalopod)
One perk of being underweight and seeking to boost caloric intake:
I get to count eating half a pint of non-dairy ice cream as an accomplishment.
flwyd: (spam lite)
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…
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.

Odin the Pirate

Monday, January 18th, 2016 05:58 pm
flwyd: (requiem for a dream eye)
In Multiverse #A, I'm at Google's Sydney office right now, chatting with coworkers and preparing for a summit exploring options for some new technology. I periodically close my eyes and think about plans for our upcoming month-long honeymoon in Australia and New Zealand.

In Multiverse #B, I'm sitting on the couch at home. We canceled our airfare after an ocular irritation deteriorated over two weeks. Every hour my wife puts a steroid drop in my right eye with a dilating drop thrice a day. I periodically take care of house organization tasks that have lingered for months.

Unfortunately, Multiverse #B is the one in which we live.

We spent most of December reading guide books, looking at maps, proposing itineraries, sharing adventure ideas, and connecting with Australasian Burners. Then on Sunday, January 3rd I woke up with a localized headache above my right eye. Assuming it was a hangover, I spent most of the day taking care of small details and hanging out on the couch looking up things about the southern hemisphere on the Internet. In the evening, Kelly mentioned that my eye looked really red and I was coming around to the idea that it wasn't just a hangover.

Monday the 4th was the first day back at work for a lot of folks, though I'd taken the holiday period to write a bunch of code on a new-to-me technology stack while nobody was sending interrupting emails. The Colorado sun reflecting on snow felt especially bright while I was outside and I still had a dull headache, but I thought I might recover. On Tuesday morning, the eye was still red, so I called my eye doctor and got an appointment that afternoon, wanting to make sure this was resolved before I left the country on the 16th. Her diagnosis was a bacterial infection in the right eye and gave me an eye drop sample of antibiotics plus steroids, targeted at thrice a day.

Even before I put the first drop in on Tuesday evening, I was feeling much better; I think the drops put in for dilation and other measurements helped clear some of the infection. By my checkup on Friday the 8th, I was feeling really good: my eye was still red with irritation, but my headache had gone and my vision was great. My eye doctor recommended I continue the drops for four days, but didn't think I needed to come back if things were feeling good.

On Friday night, however, things got worse. My headache returned and I was feeling really exhausted. On Saturday, light felt really bright and my head felt really lousy. I took some ibuprofen (which helped with the head but not the light) and we went to REI for some travel supplies. On Sunday I was mostly able to muster the energy to buy two Sydney→Wellington tickets, pack my suitcase and figure out which items I'd want on the plane.

On Monday the 11th, the world seemed really bright as I drove to work early. I met up with a colleague from Sydney and one from New York who were in town to work with me that week on improving our integration testing situation. I started to draw an architecture diagram on the whiteboard, but the glare mixed with the early morning grogginess was too intense. I grabbed some Google Privacy Week swag sunglasses and was able to face the whiteboard for an hour, then scheduled an eye appointment for the next day after my big presentation. Ibuprofen in the afternoon and the pair of sunglasses helped me finish the rest of the slides for my talk, though I was pretty drained when I left the office around 8.

On Tuesday, I was able to get through my lunch-hour talk about a new internal service development framework of which I've led the adoption in our team. Several people congratulated me, though I'm not sure it was the greatest presentation I've given. I think the ibuprofen wore off at about 12:55, and our out-of-town visitors were pretty concerned about my eye as I toughed it out for afternoon meetings. When I saw the eye doctor around five, she could tell I was having a lousy time, but couldn't identify anything specifically wrong. There was no longer any sign of the infection, but there was plenty of unexplained inflammation. She recommended I stop the eye drops and she said she'd call at noon the next day; if things weren't clear by then, she'd have a colleague check me out.

When I got home, Kelly said "If you lose your sight in that eye, I really hope you get Odin's wisdom." I was still hopeful that things would get better, but I asked if she would be upset if we canceled the honeymoon trip down under. She hugged me and was reassuring, noting that not having humans away for five weeks would make our cat feel much better. I think I summoned the energy to place a couple items on top of my suitcase that I'd remembered to pack, then went to bed.

After a restless night of sleep and an early morning awakening in our bright bedroom, I felt pretty terrible and really didn't want to open my right eye. I had a handful of nuts, took some ibuprofen, put a hat over my face, and laid down on the couch in the moderately darker living room. At 10:45 I summoned the energy to call in to my team standup and say that I'd be working from home and taking it easy, but also planing to leave the country on Saturday, so send me anything that needs my attention. I took a shower in the dark and was finally able to open my right eye, rather alarmed that it was as if I was looking through an icy window: everything was really foggy. My eye doctor called and when I explained that things hadn't improved, she had her office make an appointment for me with a local eye surgery office. In the afternoon and evening I was able to pull together the energy to get through a bunch of one-eyed code reviews that had been lingering for a while, but it was clear that I needed to take a break from my daily work of reading words on a screen.

Thursday morning found Kelly and me in an ocular exam room with the doctor looking very worried and saying I was experiencing an autoimmune response. He ordered a battery of tests from syphilis to lyme disease, prescribed a strong steroid to be taken hourly, and eye dilation drops thrice daily. On my right side I was having trouble reading even the big letters on the eye chart and my eye didn't want to stay open for even a few seconds of light. I actually went in to work after that, but mostly because it was an appealing place to have lunch. I attended the final important meeting about testing, delegated some tasks on a bug, and set my out-of-office reply to say that I'd be available for important business but that I needed to spend a few days away from email.

I woke up fairly early on Friday, so I put in an eye drop, turned on a Nusrat Fateh Ali Khan album, put on a blindfold, and spent an hour and a quarter meditating and stretching. Kelly had to work on Friday, so I put on my coat and sunglasses and took the bus to the doctor's office, figuring some walking would be good after a month of not bicycling. Eye pressure was down and after another round of poking and prodding and strong eye drops, I finally felt comfortable keeping both eyes open at once, as long as I had sunglasses to keep the light away. I was also able to walk twenty five blocks from the bank to my house, which felt pretty nice.

Saturday was another early morning visit with the eye surgeon, who had a couple other folks he was seeing. There were a couple guys who were clearly in more ocular pain than I was, so I was feeling reasonably positive, even when I took a sad glance at my calendar when my notification popped up for my Denver to LAX flight. On Sunday we went on a half hour walk to brunch and the super market, unpacked my suitcase, watched the Broncos win a playoff game, and made dinner for my parents.

Today's appointment saw not much change from Saturday: I can make out the general shape of letters at 20/20, but they're pretty blurry. All the blood tests that have come back were negative, though some are still outstanding. I keep both eyes open most of the time. Having an eye dropper next to my eyelashes doesn't cause me to flinch away automatically, though I've still got mad respect for the willpower of people who put in contact lenses every day. I've had seven visits to the eye doctor in 14 days; I think we'll hit the limit on our high-deductible health insurance plan pretty quickly :-) Although we're not in a scenic location in southern summer, Kelly and I have spent a lot of quality time together. And we're brainstorming an alternate honeymoon trip to the Hawaiian Islands for later in February, once I'm able to fully appreciate sightseeing. And I'm feeling really glad that this problem didn't develop a month later than it did.

Aye aye, mateys!
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.


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.


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.


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.
flwyd: (pensive goat)
I caught today's Democracy Now show, which collected three previous interviews with Dr. Gabor Maté. If you're interested in rethinking contemporary medicine, the hour-long program is worth a listen.

He talks about how mental and emotional health can't be separated from physical health, but since western medicine (which he also knows and practices) has a better understanding of the latter, chemical-based solutions are often applied to solve primarily social problems. For instance, in post-industrial America, many children don't get much parental attention – many companies give just six weeks of maternity leave – meaning kids miss out on important developmental processes. This often manifests later in life in damaging ways, ranging from ADHD to drug addiction to antisocial behavior.

I've been thinking recently about "ecological thinking," which I hope to write more about later, and these interviews were a good example of what I've got in mind. Short maternity leave makes sense from the short-term self-interest of the company, but a culture where the practice is widespread may, over the course of a couple generations, be significantly worse-off because its children missed out on important development.
flwyd: (xkcd don quixote)
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.
flwyd: (Vigelandsparken circle man)
This post is long; the best two paragraphs are at the end if you want to skip the minutiæ of my sleep schedule, food choices, and body aches.

On the Saturday before Memorial Day, I drove up to the ever encroaching Frederick/Firestone/Erie agropolis to drum and dance around a fire with a bunch of neat freaks. (That is, freaks who are neat to be around, not people who freak out about being tidy.) I got home around 2 AM.

On Sunday, I woke up with a slight pain in the right side of my neck. I figured it was just tight and Tam said she'd rub it for me later. I drove up past Estes Park to celebrate the occasion of my father's sixtieth birthday at our cabin. My neck felt better as the day progressed. We hiked up to Moose Plop Rock (an old standard) and came down to dinner with turkey, yams, and other tasty treats. My dad and Michael C swapped stories about the past as Mouse, my mom, and I interjected periodically and chuckled frequently. I got home around 1 AM.

On Monday, Tam and I ate a great dinner at Pad Thai with a new friend. Tam went to Red Rocks while we returned home to play Go, Gloom, walk around the lake, watch Edward Scissorhands, and cuddle in the bean bag. I fell asleep around 3:30 AM and got about three hours of sleep.

When I woke up my neck was a little sorer than the day before, but I attributed that to odd sleeping position. On Tuesday evening, I drummed at Full Moon Books. My arm and shoulder were a little sore, so I spent more time with the djembe between my knees and less with it over my shoulder. I probably went to sleep a little before 1 AM.

On Wednesday, I passed up game night at the Bakery to eat at a Pho restaurant and sign a lease for our new apartment. The Vietnamese egg rolls were great, but the real estate agent canceled at the last minute. Pain in my neck and shoulder combined with the fact that I'd missed out on hanging out with friends, playing silly games, and hearing stories of what's rotten in Denmark had me in tears in the car. Tam rubbed my neck and shoulder before she went to work out and I went home for a hot shower. I did a bad job of going to bed early, probably hitting the 12:30 mark.

On Thursday, my neck and shoulder were a little sore, but they improved before I headed up to Boulder to join [livejournal.com profile] mollybzz in a search of The Hill for people we knew, employment venting opportunities, great Thai food at Khow Thai, and a Molly Flogging of Go at the Trident. I went to bed around 1 AM.

On Friday, I woke up with significant pain in my upper right arm, shoulder, and neck. Throughout the day I worked with a constant dull pain and a frequent headache in the right side of the base of my skull (a rather unusual place for a headache). I think I winced several times while reviewing the lease when we finally met with the real estate agent. I suggested we eat dinner at Jason's Deli and soak in the hot water caves at Indian Springs resort in Idaho Springs figuring a long hot soak would loosen things up. That might have work had I been a member of the vagina-enabled class, but the men's cave's pools sat at 104°F, 112°F, and 116.8°F. At Valley View I enjoy the outdoor 108° "Hot Pot" for short periods, but I prefer soaking at temperatures a little lower than that. The 104 bath felt good but the hot, humid air combined with my persistent dull headache to make staying in the cave for more than 10 minutes at a time untenable. After a few hours spent mostly outside of the cave I was more miserable than when I arrived, but at least my skin felt soft and clean. We came home and [livejournal.com profile] tamheals gave me a massage on the table, popping my inner spine closer to correct position. I fell asleep (before midnight, I think) on the massage table and I think the hard surface did some good.

On Saturday my neck felt better, but it was still sore and I still had a dull headache. I drove out east to visit the aforementioned new friend. We paddleboated around a lake, cuddled for a while, and headed downtown to see Kan'Nal at the Bluebird. Before the show we ate at Mexcal; their mole chicken was pretty good and their green salsa was fabulous. After we walked around the block and wandered in to the theatre I realized I ought to take some Advil which I'd left in the car. Fortunately a hand stamp was all we needed for reentry and I dulled the shoulder-neck-head system. The first opening act was a DJ named Ooah. He had a MacBook and a device for adding beats and blips; his set was pretty monotonous and we walked around the block again near the end. The second opening act was Ganga Giri, a group from Australia featuring DJ, drums, didg, and an aborigine in traditional body paint singing and playing some sort of stick-based percussion. They were pretty danceable and the typical colorful Kan'Nal concert costumed attendees had filled the house. I took two more Advil before Kan'Nal took the stage and danced in place without a lot of pain. The show was a lot of fun, though the audience wasn't as entertaining as the last show I attended with Boudlerites trying out their Halloween costumes. The on-stage dancers had some great Central American-inspired costumes featuring skulls and long finger bones. They also did a great piece with pictures projected on whirling cloth. I went to sleep around 2:30 AM.

On Sunday I woke up and cuddled for a while before heading home. My head, neck, and shoulder persisted in their aches and while I'd recovered somewhat from a week of less than recommended sleep I was pretty low on energy. I spent a bunch of time at the computer (maybe not the best idea for the shoulder), and went to bead early to lay on my back and read The Children of Húrin.

This morning I woke with clarity as my alarm went off at 7. I was a fully aware listener of Democracy Now! which hasn't happened for several weeks. Feeling chipper but still sore, I got up and cleaned the litter box and made it to work before 8:30 (I've been closer to 9 most days in the past month). I decided to try a new desk position. I took my mouse off the stack of books and my laptop down from the pile of boxes, sitting the whole day instead of my usual "stand when there's lots of typing, sit when there's lots of reading" modality. I left work by 4 and paid a visit to Lakewood Chiropractic. The E-stim made me tense up, but the adjustment felt really good. Still a little sore, but feeling better, I drove towards home, figuring I'd go for a walk around the neighborhood. As I crossed Bear Creek I figured that would be a more interesting walk and, after some experimentation, discovered I could get on Bear Creek Trail from Fox Hollow a few blocks west of Kipling. I walked through the minor clouds of insects and scattered pollen down to Wadsworth, got a sandwich, and headed back in the sunset preview. Round trip a little more than two hours. I still feel pain in my neck and I've got a mild headache and I'm trying not to move my right arm far from the keyboard. I may need another adjustment, but I'll sleep on it for a while.

Over the past three and a half years I've been aware that I've neglected my physical health. Sometimes I'm focused on getting projects done at work; my school habit of placing more importance on long-term mental activities than short-term physical activities has continued in my professional life. Sometimes the path of least resistance is to come home, have dinner, and relax for awhile. Sometimes the pleasure of standing naked on the porch in the sun on the weekend feels more attractive than the pleasure of riding my bike (which can't be done naked in suburbia). But at least I recognize that when I'm in pain I need to step back and make my physical existence a priority. It's amazing how enjoyable the afternoon can be if you leave work at 4 on a beautiful day in a county with quality open space.

And now if you'll excuse me, I need to go wash all the floral ejaculate off and see what the freezer has to offer in the way of sorbet.
flwyd: (smoochie sunset)
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.


Thursday, February 8th, 2007 09:33 am
flwyd: (charbonneau ghost car)
I worked at home for the last two and a half days on the grounds that I seemed to have flu-lite (ache-free and 30% fewer calories than regular flu). I think I consumed 10 pots of tea in that time, most with lemon juice added. (Free advice: never add lemon juice to vanilla hazelnut tea.) I spent most of the time sitting at the kitchen table using my laptop; my shoulder and back aches are reinforcing my decision to stand to program at work.

My throat was still scratchy this morning, but when I looked out the window and saw thick fog as far as the eye could see, I got excited. Metro Denver only gets serious fog every few years. And after nearly two years of broken, my fog lights got fixed on Saturday. I'd be damned if I missed a chance to use them! As a bonus, the rush hour commuters who drive slowly on C-470 if there's an accident in the ditch on the other side of the road managed to handle the fog with surprising sensibility and flow.


Monday, February 5th, 2007 08:03 pm
flwyd: (spam lite)
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.
flwyd: (escher drawing hands)
I got out of bed at 11 or later this morning (in part because I stayed up watching an episode of the original Star Trek series). I spent the next several hours expelling phlegm from my upper body, but my head felt pretty clear. I cleaned the felavitory (aka the cat box), had relationship discussions with Tam, had a shower, and started cooking turkey soup.

After my slow and steady vegtable cutting and other cullinary business I sat down with a bowl of said soup and read Wikipedia articles about the Chinese lunisolar calendar (maybe I should get an account so I can link this to the Chinese remainder theorem), Chinese numerals and number systems, the five elements, and I Ching. After that, I stopped sneezing and dribbling every five minutes, meaning I get 6 hours of sick-free time in a four day extended weekend.

At Tam's request I then proceeded to make some tasty baked apples, drink tea, and watch Family Guy. None of this involves actual writing, so my impressive word count for the day is 716. Those words are all in Lake over Water, ䷯: Oppression (Exhaustion). It's the shortest chapter I've written so far, and I've been unsure of how I was going to make it work for at least a day. I can tell that what I wrote is somewhat incongruous with the traditional wisdom of the hexigram. It also doesn't do a very good job of defining the two characters, who I'm still not sure how to handle.

My total word count is 18927, 13719 on the I Ching story. However, Wednesday and Sunday together came to only 1,000 words (a decimyriad), so at least I'm above 2,000 on a good day. Since I'm clearly not going to reach 50,000 by Thursday, I suppose I should start measuring progress in hexagrams, of which I've done 12 (20%). I'd like to hit them all in a "month," say by dawn on winter solstice. In the hexagram measure, I need to pick up the pace a bit, especially since I don't have another four day block to sit around in my gnome pajamas and only leave the apartment to throw trash in the dumpster. But it's comforting to see that I could write more than twice as much in less than half the time when I've got the right subject matter
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