The scientific community assumes the same rules of communication are always applicable and rational, that people are attentive, open minded, persuaded by facts and believe that those who are presenting information are people of goodwill, and not deliberately trying to manipulate them. But none of those things are true.
Yankelovich and Rosell have identified a process that they call the public learning curve that describes maturing public opinions, where people's views evolve from poorly informed reactions to more thoughtful conclusions. The three-stage process begins with building awareness and consciousness (where advocates and the media typically do a good job). The seecond stage involves working through wishful thinking and denial, resistance to change and mistrust, grasping at straws, deliberate obfuscation and lack of urgency (which is where dialogue comes in). The third part of the learning curve is when people come to resolution (which is handled by decision-makers and government institutions). "Much of our work focuses on improving the 'working through' stage, which our society does not handle well and where critical issues like climate change can get stuck for years or decades," said Rosel.
– James Hoggan, I'm Right and You're an Idiot: The toxic state of public discourse and how to clean it up
, chapter 1 with Daniel Yankelovich and Steve RoselThis entry was originally posted at http://flwyd.dreamwidth.org/368384.html – comment here or there.
Close to two months ago, my weight was hovering just about 110 pounds.
With a calcium channel blocker, I was able to eat a normal day's worth of food and not regurgitate most of it, so I managed to gain about 10 pounds in a month.
Making further progress on my annual goal of gaining 30 has been challenging, and I've hovered around 120 for the past month.
I weighed in at 120.5 on Saturday morning.
After a weekend of clear liquid, I'm heading into surgery at 115.
I'm quite glad I was able to invest in that fat buffer.
Here's to hoping I'll be able to swallow a lot of soft calories in the next two weeks.This entry was originally posted at http://flwyd.dreamwidth.org/368187.html – comment here or there.
I've been surprisingly calm about my achalasia surgery tomorrow.
After scheduling it, I haven't had any second thoughts, bouts of dread, or even niggling worries.
Most of our office is playing musical chairs at the end of this coming week, when I'm out. So my last act of heavy object lifting for a while was packing my desk on Friday. This should help me unplug from work while I'm at home recovering: there is no longer an ethernet cable connected to my computer, so I couldn't SSH in and hack on something if I wanted to. (Email, of course, is a much more sinister temptation.)
I spent most of this week fighting a cold, which helped put me in "Hang around the house not expending much energy" mode but didn't help in the "fatten up before surgery" department. The cold reduced my appetite and severely depressed my appetite for sugar. Not wanting sugar sounds like it would be a good thing, but I had to spend this weekend on a clear liquid diet
, so I'd been planning to get most of my calories from sweets.
My mom got me a jar of unflavored gelatin for Christmas (before she knew I was having surgery). Gatorade powder, gelatin, and water turns out to be a pretty tasty way to get some calories, protein, and electrolytes. And if you halve the recommended gelatin to water ratio it's pretty easy to drink. I should try this combo at Burning Man.
I had my last meal, of sorts, at Sushi Zanmai on Friday night. I wasn't especially hungry (because of the cold), but ate a bunch because it was so tasty. Rice and fish are some of the first items in the solid portion of the recommended recovery diet progression, so maybe I'll be able to return before too long. I had a hamburger at lunch and probably won't be able to do so again until the end of March. Maybe it'll be my half-birthday treat.
Part of my plan for recovery time was to read The Conscience of a Conservative
so I'll be better prepared to have conversations with Republican lawmakers and potential issue allies on the conservative side of the spectrum. My plan for Saturday was to visit used bookstores until I found a copy. After five bookstores and $120 I didn't have any Barry Goldwater, but I did end up with a copy of A People's History of the United States
. I also overheard a Bookworm employee tell a customer that they were sold out of 1984
. I didn't end up without materials to strengthen my transpartisan dialog skills, though: Don't Think of an Elephant!
, I'm Right and You're an Idiot
, and The Righteous Mind
are now in my possession. I still intend to read TCoaC, but now my plan is to borrow a copy from the public library, which seems like an especially apt approach to that book.This entry was originally posted at http://flwyd.dreamwidth.org/368001.html – comment here or there.
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."This entry was originally posted at http://flwyd.dreamwidth.org/367606.html – comment here or there.
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.This entry was originally posted at http://flwyd.dreamwidth.org/367339.html – comment here or there.
President Trump is expected to sign an executive order today
which restricts visas from seven predominantly Muslim countries. I sent the following message to my senators and on the White House's contact page
(since apparently the Trump administration has declined to answer the phone when Americans call
I am a lifelong Colorado resident and I’ve voted in every election since I turned 18. I am writing to express concern over the executive order regarding visas that President Trump is expected to sign today. This order would restrict U.S. entry for people from Iran, Iraq, Syria, Yemen, Libya, Sudan, and Somalia, even for people who already live in America. I oppose this ban for three reasons: it’s bad for American business, it won’t make us safer, and it hurts families. I urge you to call President Trump and let him know that this order is not consistent with the values of America or our people.
Life in all of those countries has been quite challenging in recent years and many folks have decided to seek a better life in America. Many of the people who have fled are highly educated and have been making valuable contributions to the American economy as scientists, engineers, doctors, and more. From Iran in particular the United States has benefitted from over three decades of contributions from expats. Several highly skilled Iranians have helped my company deliver billions of dollars of value in the American economy.
This policy would not make America any safer. In the list of terrorist attacks in the U.S. on Wikipedia the only perpetrators I found connected to those countries were two by ethnic Somalis and one Yemeni man; all three cases had small impact. Meanwhile, the 9/11 attackers were predominantly from Saudi Arabia, which is not covered by this ban. The people who emigrate to the U.S. are typically opposed to these countries’ governments and are seeking a more stable life than the chaos at home.
Finally, this order would hurt families. Folks living in America–many of them U.S. citizens–would be unable to visit their families or have family members visit the U.S. This could break up marriages, strand children, and keep Americans from attending family weddings and funerals.This entry was originally posted at http://flwyd.dreamwidth.org/366960.html – comment here or there.
Part of me wants to stop listening, turn away, and get America's unpopularly elected president out of my head. But he's got an uncanny narcissistic knack for getting people to pay attention to him. So here's some commentary on pieces of Trump's inauguration speech
In a speech whose overall tone was jingoistic nationalism, this stood out to me:
We will seek friendship and goodwill with the nations of the world – but we do so with the understanding that it is the right of all nations to put their own interests first.
It sounds like Trump misunderstands friendship. When a good friend is in need, we put aside our own interests to help them out. We lend our friends money at no interest when they're in a jam. We put our own reputation on the line to vouch for a friend's character. We sit our friends down for an uncomfortable conversation when they need an intervention.
Friendship is a long-term relationship that often involves personal sacrifice to help the other. We do this because at some point, at a time unknown and with no guarantee, the friend might be in a position to return the favor. Trump's line does not describe friendship. Perhaps the term he was looking for was "business partner."
Trump launched his campaign by impugning Mexican immigrants as rapists and drug dealers and made anti-immigrant bluster a cornerstone of his rallies, so it's no surprise it was a key point in his inauguration speech.
Every decision on trade, on taxes, on immigration, on foreign affairs, will be made to benefit American workers and American families.
There's actually a really elegant solution to this. If you make it easy for immigrants to become citizens, more Americans will be employed and more American families will contribute to society.
Trump continued on one of his favorite topics, borders. (Although the U.S. only has two, and Trump only seems to care about one of them, so perhaps he should make it singular.)
We must protect our borders from the ravages of other countries making our products, stealing our companies, and destroying our jobs… We will bring back our jobs. We will bring back our borders. We will bring back our wealth. And we will bring back our dreams.
"We will bring back our borders" is an odd choice of wording. Make America 48 Again? Maybe he wants to renegotiate the Louisiana Purchase as a public-private partnership
The first sentence is somewhat surreal too, and not just because "ravages" seems out of place. Despite corporations counting as "persons" under U.S. law, a foreign intelligence agency can't kidnap or steal a company. And I'm not aware of major American companies disincorporating and moving to another country, perhaps because Delaware is such an effective tax shelter. (There have been some notable international purchases of American companies, perhaps none more ironic than Budweiser being produced by a Belgian firm.) Additionally, the United States is still the top manufacturer in the world
, we just mostly make stuff with really fancy machines and not a lot of people (high capital, low labor). Finally, a lot of wealth has stayed in American accounts: since the companies are still American, their stocks are traded on American exchanges, and the corporate executives haven't been outsourced, wealth gains from globalization haven't fled the country: they flowed to the American 1%.
Finally, Trump is personally an odd champion for trade protectionism and a call to bring jobs back to the U.S. He makes a lot of money from hotels and resorts around the world, employing thousands of non-Americans. It would also be nonsensical to fill those jobs with U.S. citizens: you can't outsource cleaning a hotel room in Manilla to someone in Toledo. These properties also put Trump in a compromising position in his quest to put America's interest before its friends: will he put the U.S. first if, say, Trump Towers Istanbul
becomes a pawn in negotiations with Turkey? Would he stick to his protectionist stance if his family was offered the chance to build Trump Tower Guangzhou?This entry was originally posted at http://flwyd.dreamwidth.org/366658.html – comment here or there.
I am a lifelong Colorado resident. My grandfather represented the San Luis Valley in the legislature in the 1950s and my great grandfather gave the first sermon on Pike’s Peak. I have voted in every election since I turned 18.
I am writing you on the occasion of Martin Luther King Jr. Day to express support for immigrants and disenfranchised citizens and because I am concerned about the political tone in the United States. Dr. King expressed a dream, based in the ideals set forth in the founding documents of our nation, that everyone in America would be judged not by the color of their skin but by the content of their character. And while major strides were made in the second half of the 20th Century, this dream often seems a long way off. The president elect and many other prominent voices have proposed a vision for America which seeks to deny the American dream based on demographics, denying people the chance to prove their inherent worth.
America has been built by half a millennium of immigrants, creating wealth and innovation like the world has never seen. The first of my ancestors to arrive came from England in the 1600s; the last arrived from Norway and Wales near the end of the 19th Century to farm and mine in America, working hard to support their families and, in the process, helping America grow. Today’s generation of immigrants contributes immeasurably to American society and the United States economy, from migrant farm workers to the CEO of Google.
Mr. Trump and many other prominent voices have tried to foment xenophobia and anti-immigrant sentiment for political gain. Mr. Trump has proposed signaling out members of specific religious groups for enhanced government surveillance, building a fence to rival the Great Wall of China at a cost around 40 billion dollars, and deporting children (future American entrepreneurs and laborers) for whom the United States is the only home they’ve ever known. This plan not only goes against the American values that Martin Luther King elucidated, it also works against our economic interest. For the U.S. economy to thrive in the coming generations, the country must grow. The native-born American population is aging and shrinking. Immigrants tend to be young and work hard, filling important roles, spending money in the American economy, and fueling job growth. The United States risks an economic and budgetary crisis as our population ages if we do not welcome the innovation and determination of immigrants seeking the American dream, fleeing war and economic despair abroad, just as immigrants have done for the last four centuries.
As my voice in Washington, I call on you to speak out, both privately and publicly, when Mr. Trump, his associates, and other members of the political establishment make judgments of people based on the skin color, national origin, gender, religious beliefs, or sexual orientation. Furthermore, I urge you to sponsor and vote for legislation which reforms the U.S. immigration system, paving a path to citizen ships and creating an egalitarian and welcoming nation. I also urge you to take action to stop discriminatory policing, reform racially biased sentencing guidelines, ensure equal pay for equal work, and end government interference in people’s selection of restrooms.
Thank you for your service to our country,
Trevor StoneThis entry was originally posted at http://flwyd.dreamwidth.org/366458.html – comment here or there.
This weekend I created a Dreamwidth account
and copied all my LiveJournal posts there. I plan to use Dreamwidth for future composition, automatically crossposted to LiveJournal. I don't plan to delete any LJ content, and you can leave comments on either site. I'll still read my LJ friends page and will cultivate new connections on DW. For background, read on.
I created my LiveJournal on June 12, 2001, turned on to the service by slyviolet
. In my first post
I set an intention of using it to track memoirs and musings, share interesting links, and support the site as an open-source, volunteer-run project. My use has followed this overall tenor, though the style has evolved quite a bit–as has the LiveJournal ecosystem.
In the last fifteen and a half years, I've written 1,429 posts with (I think) at least one in every month during that span. My update cadence was much higher in college than it's been during my professional life, with a significant drop-off in 2010 as I started getting my social media fix through company-internal venues. English-language LiveJournal usage has dropped significantly during the Obama administration, probably due to the rise of Facebook, Twitter, Tumblr, and other "Social Networking 2.0" sites. I stuck around because (a) I already had a decade of content on LiveJournal and (b) the site's design and community supports long-form content, which is sorely absent in today's volume-focused social media landscape.
A faction also started leaving LiveJournal after its acquisition by the Russian firm SUP Media. Dreamwidth
launched in 2009 using a fork of the open source LiveJournal code base, a modified subscription/access model, a different terms of service, and no ties to Russia. Dreamwidth attracted a significant slice of the English-language geekery and fan fiction demographic from LiveJournal.
Recent weeks have seen a renewed migration from LiveJournal to Dreamwidth. This post
summarizes some of the drivers, in particular the fact that LiveJournal's servers now seem to be physically located in Russia and the contemporary political climate in Russia is somewhat bleak on the free speech front.
To a software engineer like me, the idea of mandating a particular piece of the web reside in a particular country is ridiculous. The whole point of the Internet is that people from anywhere in the world can share data with people anywhere else in the world. TCP packets don't need to show their passport at the border and a connection between New York and Los Angeles could pass through London, Dubai, and Tokyo if that turns out to be the fastest route. Yet as the Internet has grown to be of more political and commercial prominence, several governments have taken a keen interest in the geographic location of stored data
. Sometimes these laws (proposed or passed) happen because legislators don't understand new technology, so they legislate computing the way they would legislate paper. Sometimes the laws seemed to be based on a desire to drive infrastructure development in their country: "If we require Brazilian users' data to be stored in Brazil, tech companies will build more data centers in Brazil, which will drive jobs and tax revenue."
If these were the only two reasons to require data geolocation, LJ servers in Russia wouldn't be a big deal, aside from perhaps slower page loads from the U.S. Unfortunately, several countries have passed (or would like to pass) data location laws so that user content can be subject to local jurisdiction. And, if you're cynical, the government might also want the data to be available for a police raid where they grab hard drives from the data center. In the specific case of Russia, having data subject to Russian law may be of concern, as the Duma has recently passed laws restricting free speech
in ways that would feel uncomfortable to many folks in the west. I'm not sure that the "cops with guns and USB cables" scenario puts your LJ data at significantly more risk today than five years ago: Russian hackers have been plundering data from around the world for over a decade and the Kremlin could probably exert pressure on SUP employees to reveal data they steward, regardless of where it's stored.
If you're a LiveJournal user and care about your content, I think it's wise to create a Dreamwidth account
(free or paid) and back up your entries (it's easy
). Even if the Russian government or hackers have no interest in your journal, having a backup of your data puts you in a more robust position if SUP goes out of business or turns out to be unprepared for a technical disaster.
Additionally, LiveJournal seems to have turned off HTTPS encryption: https://www.livejournal.com/
now redirects to http://www.livejournal.com/
and likewise for individual journals. This seems like a pretty suspicious setup in 2017, when anybody and their uncle can get an SSL certificate for free
. So you should probably assume that somebody's listening in on your LiveJournal traffic, regardless of what you think Russian actors (or anyone else) might want to do with said data.
Ironically, moving data outside the U.S. may actually make it moderately easier
for the NSA to get at it, since they have to invent complex procedures to legally snoop on U.S. citizens' data within the U.S. but have more statutory freedom to raid international data. If you want to keep your writings protected from the five prying eyes of the world's spy agencies, your best bet may be pen and paper. If you want to store it digitally, strong encryption and public-key based individual sharing is a good (though not very user-friendly) approach. The best balance may be a major tech company which has the resources to spend on high-quality security engineers and is willing to spend big bucks fighting court orders to secretly hand over user data
. The big corp, even though they have a closer relationship with the government, may stand a better chance of defending your data than a small startup founded on principles of pure privacy
.This entry was originally posted at http://flwyd.dreamwidth.org/366249.html – comment here or there.
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.
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.
- Dairy (milk, cheese, cream, butter… anything derived from a mammal's udders)
- Eggs (this prohibition adds a lot of challenge to my diet)
- Extra-virgin olive oil
- Red wine
- Capsicum peppers (both spicy and bell)
- Peppercorn/black pepper (basically anything with the word "pepper" in it)
Since several spices have led me to have absolutely miserable days, I'm taking a very cautious approach to spice. I'm able to handle cinnamon, cumin, ginger, and garlic. If a product lists "spices" as an ingredient, I don't eat it. For individual herbs and spices not explicitly listed I decide on a case-by-case basis. If there's a spice you'd really like to bring to Thanksgiving (particularly in the savory category), let me know and I can do a trial in advance–I'd love to collect some more data.
I'm also taking a cautious approach to highly acidic foods like tomatoes, many fresh fruits, and alcohol. I might accept these if offered or I might decline.
Fat, sugar, and salt are all good. I'm currently dramatically underweight, so the standard dietary advice given to Americans doesn't apply to me–I'm finishing a whole pint of non-dairy ice cream as I write this and I eat plenty of bacon. I can eat plenty of fat as long as it doesn't make food stick to the throat like salad with dressing (and as long as it's not butter). High sugar is fine too; my morning smoothies feature honey, molasses, or syrup. My dietitian also recommended I have 50% more sodium than the max recommended level, so salt is fine. (I'm currently trying to keep dietary fiber low, but I don't worry much about fiber content at social events, so don't sweat it.)
Common food restrictions:
Other than dairy and eggs, I seem to be okay with all the common allergens (nuts, legumes, gluten, soy, shellfish…). I don't follow any preparation-based restrictions (kosher, halal, raw, fair trade…). For the most part, if I can easily swallow it then I want its calories in my belly.
I know you mean well, but whatever diet or food you've heard is good for something or other is probably not applicable to me. Most diets have weight loss as a goal, but losing more weight would significantly compromise my health. It's hard to sell diet books if weight gain is a side effect, so if you've heard of a diet, it's probably not right for me (unless you've got a good recipe for chanko nabe). Similarly, I'm actually trying to avoid anti-inflammatory foods for a while. When I was diagnosed with an autoimmune disorder I went full haul on anti-inflammatories. Unfortunately, I think the COX-blocking effects may have negatively impacted my gut, so I cut them out of my diet (with the exception of omega-3 fatty acids and ginger). If you saw an article about some wonder food or supplement, I'm probably avoiding it.
Despite growing up in Boulder, I'd never seen an owl in town until Halloween of 2005 when Tam and I were waiting outside the Fox Theatre to see My Morning Jacket
. An owl was chillin' across the street, probably above Albums on the Hill. We figured he might have tickets to the show, because they'd just released the album Z
with this lovely cover:
The next time I saw an owl in Boulder was, IIRC, a little after midnight on November 2nd. I was standing on top of the parking garage after the annual DeVotchKa
Halloween show and an owl was hangin' out atop the new condo at 15th and Pearl. Maybe he'd just seen the show, too.
This year, I didn't go to any Halloween concerts. With my troubles eating lately, three hours spent expending calories by dancing and not eating anything has seemed like a risky proposition. But early this evening, as Kelly and I were raking leaves out of the ditch in front of our house, we heard an owl hoot. We looked up to the mostly bare tree across the street and saw the telltale silhouette of an owl perched on the highest branch. Maybe he missed seeing me at the show and wanted to check in on me.
Thanks, owl. It's been a rough year, but I'm hanging in there. I'll make it to next year's show.
One benefit I had not anticipated from wearing a wedding ring every day is that it gives a tactile warning when I'm dehydrated because it's loose and slides around more.
The danger is that when, say, I'm doing yardwork while dehydrated, there's a danger that the ring will slide off my finger into a big bag of dry leaves. Good thing I love playing with leaves.
This is one of my favorite weeks of the year. In the span of 8 days, I'm celebrating my first wedding anniversary, International Talk Like A Pirate Day, the autumnal equinox, my 37th birthday, and my first chance to host a game day after the late summer festival hiatus. Come help me celebrate, this Saturday!
The Day: Saturday, September 24th.
The Time: Arrive after 2pm, leave when you get tired or think of something better to do
The Place: Lucky Gin
The Phone: 303-EEL-WANG
Bring friends, games, food, kids, drinks, and stories of fun summer adventures!
If you're hoping to have me try the food you bring, note that my diet is still bizarre (and too complex to explain here), but I've been able to eat significantly more foods this week than I could earlier this summer. So bring something tasty, and if I can't eat it, all the more for the rest of you :-) If I time it right, I should be pulling a garden-fresh, egg- and dairy-free zucchini bread from the oven around the start of the event.
See you Saturday!
(Oh gods am I happy to be eating bready substances again. My trial-run zucchini bread was still warm in the oven when we got back from the movies to night. So soft and moist and comforting!)
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…
I don't use Facebook at all, but I think I have at least three accounts.
The first is an account they created when my friends signed up for Facebook and let it run through their email accounts looking for contacts. They checked a box next to my name, which Facebook took as a signal to create an account for me and periodically send me a message letting me know that I've been invited to their service.
The second account is for my work address. Someone with the same first initial as me who isn't very good at using the Internet created a Facebook account and entered my email address. Facebook sent me a couple messages letting me know I had one more step I needed to complete to start using the service. After a while, they switched modes. That account is in an experiment wherein they email me every day. The subject has the names of three people I might know on Facebook and the body has three more names. The number of names in the subject that I recognize is remarkably high for a big company, so I think the Facebook app on Android uploads your phone's Contacts list (i.e. the people you email occasionally) to Facebook.
I just learned about a third Facebook account I have. I received two emails and a LinkedIn friend request from a Facebook recruiter this morning within the span of one minute. The first email was sent to my personal email account (not the one printed on my résumé) and the address email@example.com. That's pretty clearly a 64-bit integer, which is what a database like Facebook's would use as a user ID. I sent a test message to that address and it wasn't delivered to me, so I don't think it's meant as an alias for delivering mail to me. Maybe mail sent there gets appended to a communication log on my Facebook Job Prospect account.
Some people wonder what Facebook does with all the data about themselves that they give it.
I wonder what Facebook does with all the data about me that I never gave it.
Anyone want to guess how many accounts Facebook has about you?
Taking advantage of the long weekend, I harvested 8 pounds of rhubarb on Sunday. This evening I started (with Kelly's help) a batch of rhubarb melomel with 3.5 pounds of it. ("Melomel" is just a fancy word for "mead with fruit." Unless the fruit is grapes, in which case it's a "pyment," or apples, in which case it's a "cyser." This concoction is perhaps more appropriately a vegomel.) I boiled the rhubarb in water and half a cup of lemon juice and within an hour the rhubarb had separated into particles the size of oats or so. Then I zested a lemon into the rhubarb, sliced it into eighths, and tossed those in. The rhubarb taste is already nice and smooth; this concoction is going to be fabulous during the Yule-Christmas-New Year gauntlet. I might throw a few more pounds into the secondary to bring some enhanced tartness to the final output.
So as to make maximum use of a clean kitchen and sanitized equipment, we made extra must with the honey and started two 1-gallon batches without any extra ingredients. One (or maybe both) will get violet leaves in the secondary; I'm thinking hawthorn berries for the other, particularly if I harvest more in time this fall.
We've got about 25 lbs left of the Dutch Gold organic Brazilian wildflower honey
we got in bulk for the last batch. That's enough for two dry meads; Kelly has plans for a lavender metheglin. ("Metheglin" is, of course, a fancy word for "mead with herbs.")
Also, I think drinking honey is good for my throat :-)
Organizing my thoughts for a gastroenterology appointment on Friday, here's what's been going on with my esophagus and stomach lately.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.Bowel Movement and StagnationGrain proteinsLegal drugs
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
. 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.
Today's Conference on World Affairs
Howard Higman Memorial Plenary was by former South Carolina congressman Robert Inglis, who is now the executive director of republicEn.org
, a site and nonprofit organization run by conservatives concerned about climate change focused on swaying other conservatives about the issue. The talk was entitled "How Free Enterprise Can Solve Climate Change" (video here
) but it wasn't so much an economics presentation as a discussion about what it would take to convince conservatives (and particularly conservative U.S. politicians) to implement a carbon tax. In particular, he argued that for the right wing to buy in, it needs to be a revenue-neutral, border-adjusted carbon tax
Revenue-neutral means the money earned by the tax needs to be offset by cutting taxes somewhere else. The plan needs to be revenue-neutral because you can't get the Republican party to agree to a carbon tax which will also increase the size of government.
Border-adjusted means that an import tax on carbon would be imposed if the goods came from a country which didn't tax carbon at the source of production. The border adjustment is important because it would let individual countries set up taxes on their own (without requiring worldwide coordinated government action), but would make American-made goods which paid the carbon tax (or were developed with cleaner technology) competitive with foreign-made goods from countries which use cheap but dirty production methods.
The focus wasn't so much on the mechanics of how such a scheme might be implemented, but rather on how climate change believers might effect action on the issue through a congress whose position over the last two decades has ranged from skeptical to hostile. Speaking to a Boulder audience dominated by folks on the left, Inglis talked about how to frame the conversation in terms that a conservative (like your uncle Charlie at the holidays) can support. Inglis's own history went from opposing climate change legislation based on no knowledge except that Al Gore supported it (mid-90s) to introducing a bill which would tax carbon and cut payroll tax (2009). The bill died, and he was thanked for his efforts by being defeated by the Tea Party in the 2010 primaries.
Inglis's biggest topic of framing was on tax. A plan that sets out to make things like manufacturing and driving more expensive is on shaky ground with Republicans already; if it sends more money to Washington, they'll stop listening. He wasn't especially particular about the way in which taxes were reduced, though he called out a corporate income tax reduction as a particularly attractive option for swaying Republican lawmakers. He said that many liberals seemed unwilling to reduce corporate income tax in exchange for a carbon tax and he questioned how much those liberals were truly convinced that climate change was the most important issue of the generation. (One could play the same trick on any number of issues: offer to cut income tax but make it revenue-neutral by imposing a tax on firearms and ammunition and see how committed conservatives are to income tax reduction.)
Of the revenue-neutral schemes Inglis mentioned: payroll tax, income tax, or a dividend, I think the latter is best-suited to balance a carbon tax. If the dividend were distributed equally to all American citizens, it would be a much more progressive tax benefit than cutting the corporate rate. Furthermore, an annual cash payment to everyone, even if they are currently unemployed and thus not paying much payroll tax, would help people cover the costs of increased energy bills, buy a more energy-efficient car, move away from rising sea levels, or otherwise cope with the new world of climate change.
I asked Inglis about the details of border-adjustment and whether it would account for non-tax incentives which lower the price of carbon production like foreign aid to Saudi Arabia and Venezuela or governmental policies by a country like China which provide polluting industries with benefits like unrestricted access to land or other perks. Inglis wasn't concerned with internalizing all
externalities, and he also said the import duty would be based on the carbon content of an American-equivalent product, meaning that as American production becomes less-polluting, carbon-derived imports will get cheaper. I'll let the economists hammer out the details on this front, though.
I think Inglis's most important focus isn't on the policy specifics, but on reaching out to Republicans and conservatives as one of their own
. He (and the folks republicEn can gather to their rallying call) can speak the free enterprise orthodoxy lingo that progressives aren't as fluent in and he can appeal to them from heart-felt religious conviction grounds upon which even religious liberals, let alone secular scientists, don't stand. (This isn't to say that religious liberals don't have religious conviction, but that their dogma has evolved so significantly from conservative religious dogma that attempts at convergence mostly end in a lot of barking.)
Unfortunately, the opportunities for reasonable and rational engagement across ideological lines seems to be shrinking faster than polar ice caps. In the past, the stereotypical conservative uncle Charlie and liberal niece Linda listened to similar news sources and spent time with overlapping sets of people and so could converse with a shared view of consensus reality. Today's media (broadcast and social) is so specialized that it seems difficult for folks on either side of the spectrum to agree on terminology and facts, let alone discuss a policy approach with a cool head. And it seems like at a holiday gathering that Linda's mostly on defense in response to Charlie's rants about gays or immigrants or guns tough to even start a conversation about sea level rise and crop failure. If instead of a holiday, Linda tries to start the conversation on Facebook, it's easy for Charlie to glance at the subject and skip right over it, avoiding discomfort and hitting the Like button on an inspirational message in a colorful font. Meanwhile, broadcasters and publishers can get more advertising eyeballs if they present the "opposing" side as other
, which puts politicians interested in collaboration in danger of being scorned by their in-group.
Climate change is a global problem and it needs pan-ideological work to address it. Unfortunately, building a coalition ain't what it used to be.
I just realized that I'd posted a bunch of great one-liners to my Twitter feed
but hadn't added to my signature quote file
. I'd forgotten a bunch of these jokes, so I'm glad to see Twitter is solving the role of my mom's "Write it down!" pleas from my youth.
You can play a really believable game of "The Floor is Lava" in Hawaii.
Ask me what's the hardest part of investing. What's the har... Timing!
You gotta fight / for your right / To ferrrrrrment - The Yeasty Boys
The incoming call said "unknown number," but I don't know how that could be: I've memorized all the digits from 0 to 9.
Ornithography: The study of V shapes in the sky.
I got a toy alien with some assembly required. When I put it together it said "We come in pieces."
What do you call a troubadour who can play the lute without hands? No holds bard.
The little self-esteem engine that could.
Who makes the best Indian tacos? A Sioux chef.
It's a bold! It's a serif! It's digbatman!
Mallard abduckted. Fowl play suspected.
So tell me... are you a coelaCAN or a coelaCANTH?
Castling is the chess equivalent of the quarterback scramble.
Nipples are a child's first user interface.
I really hope somoene has a writing program for inmates called "Prose and Cons."
A cat holding a sign that says "9 Lives Matter"
John Jacob Jingleheimer Schmidt / 192.168.1.2 / His IP is my IP too
My imaginary friend lives at 127.0.0.2
In the land of the blinds the Venetian is king.
The process of opening and setting up a new Apple product is delightful and elegant until you get to the Software License Agreement.
After the State of the Union comes the Principality of the Dominion. A bear managing mutual funds
would probably overinvest in agricultural commodities for fall delivery.
Someone should make bumper stickers for New York that say "Maybe honking will help."
My cat loves when it's wet outside and dry inside. When it rains, it purrs.
They should have a Tour de Portland where at each stage the couriers pick up a different bulky package for delivery on the next stage.
Cat food flavors: beef, chicken, salmon. Why not mouse, sparrow, or goldfish? That's what they really want to eat.
Cats are both soft and sharp, yin and yang.
I'm noodling around on a jazz piece by Sun Ramen.
All my exes blocked my textes.
If you think stereotypes are bad, wait until you hear how inaccurate my monotypes are.
Some say if you're not paying then you are the product. Yet also: if you get paid for your work then you are the product.
Function, method, procedure, routine. Why don't any programming languages have maneuvers?
Thank you bishop, but the king already castled!
Thank you Mario, but the princess is the protagonist in her own feature film!
Professors gonna profess.
I don't think I'd want to live on a nudist, sun-worshiping plantation with people who only eat coconuts, but I think I'd enjoy visiting for a few days. The Wikipedia article has some pretty amusing stories of a crazy German man.
Originally posted by prettygoodword
(KOH-kuh-vor) or cocoivore
(koh-KOH-ee-vor) - n., someone who eats coconuts.
Especially, one who eats ONLY coconuts. Yes, a real thing, or was. This has been showing up lately because of a recent translation of a novel
about August Engelhardt
, leader of a cult of cocovorous nudists. Read the Wikipedia article.
A TSA checkpoint, an overnight flight with guaranteed less than five hours sleep, a two-and-a-half hour layover, and a late morning (oh so late, for yesterday's morning) flight kinda erase any relaxation benefit from a Hawaiian vacation.
But man, home never felt so relaxing.
 All(?) flights from Hawaii to Da Mainland are overnight, I assume to avoid fighting the trade winds.
Some thoughts after a week in Maui, in no particular order:
When you're surrounded by ocean, rainbows are easy.
Even tropical fruit is expensive in Hawaii.
When Hawaiian kids thank someone for giving them candy, do they say "Mahaloween"?
If you stick your ears in the water, you can hear the wails of whales.
On Maui, it's even relaxing to be stuck in traffic.
When the sun sets over the ocean, rather than over a mountain, the clouds lose their color right away.
I wonder which immigrant group is the source of the ubiquity of macaroni salad.
When the ocean is involved, you can make plans, but don't assume the details will be the way you want them.
It's hard to recognize the right street sign when all the place names use the Hawaiian alphabet. "Our street, uh, starts with a K, ends with an i and is about three vowels long."
If you tell people you're on your honeymoon, they invariably smile and say "Congratulations!" Consider having a honeymoon that lasts for years.
Getting in the water from the shore is free, but if you do it from a boat you don't get sand in your swimsuit.
Reggae has played a big influence on contemporary local music. Surprisingly, hip hop doesn't seem to have made it to the islands.
Jet lag is no big deal in Hawaii. Dawn is about the time I'd be getting up at home, and it's also a good time to hit the water.
Even turtles go on vacation.
"Spam sushi" might sound unappealing, but call it musubi and it's delicious.
Dear thieves who rummage through the center consoles of unlocked parked cars in the middle of the night,
I leave my car unlocked because there's nothing worth stealing in it. The $20 Target sunglasses with scratched lenses and a missing chunk of plastic have no resale value. The similar pair that's missing one of the ear pieces is worth even less. Please leave all pairs of cheap sunglasses in the car: they aren't much use to you, but they will help me get to work in the morning.
the guy with a beat up Subaru
Last month, on the Thursday before the Saturday on which I was scheduled to fly across the Pacific Ocean, I couldn't bear to keep my right eye open for more than a second because everything was bright and painful. The eye surgeon gave me a prescription for durezol, a steroid in eye drop form, to be taken every hour while awake, plus dilation drops three times a day. He told me to come back the next day. "I assume I shouldn't fly to Australia on Saturday," I said, having already resigned to the honeymoon cancellation. "Not unless you're going straight from the tarmac to a doctor's office," he said.
It's Thursday again, and we've got tickets to Maui. Half as far as New Zealand and for half as long, but I have twice as many functioning eyeballs, so I'll call it even. I'm about as packed now as I was a month ago, but I feel much more ready to go.
Man, Maui isn't an easy place to set up last-minute travel. I'm definitely going to need a vacation after the stress of setting up accommodation for two weeks.
I miss the days of getting off the bus in a new town and walking around the square to see which hostels have space.
But I'm super glad I can get to Polynesia at all. Hawaii is half way to New Zealand, and two weeks is half as long as a month. Yet I've got all of my eyes
, so I'll call it a blessing nonetheless.
I also found it refreshing that you can identify a small local business by their complete lack of adherence to modern professional web design. Like this eco-friendly rental car company