pktechgirlbackup: (pktechgirl)
I found one that addressed every single one of my issues with 3rd-world-poverty focused charities: GiveDirectly. To a first approximation, their model is to wander around Africa looking for poor people and give them money. The end.

It's a little more complicated than that, of course. They have better ways of finding poor people, for one, and they only work in Kenya and Uganda, because they recognize that there are differences between African countries and expertise developed in one does not automatically translate to another. They also do a fair amount of follow up: not in directing how the recipients should spend their money, but in measuring its impact on the families in question and their communities as a whole. One objection to cash transfers is that recipients will blow all their money on booze. GiveDirectly can tell you exactly how much spending on alcohol changes after the transfer (answer: it goes up a little, but not much). Another is that it will create resentment within the community outweighing the financial benefits. GiveDirectly measured that and found that it not only didn't happen, but communities with transfer recipients ended up slightly better off than control communities, indicating a spillover effect.

Even if the research results were not so favorable to them, the mere fact that they're doing the research makes them a good form of charity. This is a very new form of organized charity and they're not going to get it perfect right away, but they clearly recognize that and are doing everything they can to hone themselves. Moreover, they seem to have a very good sense of their own limitations. Their goal is not to replace every form of charitable giving, but to be the measuring stick for other forms. "Are you more effective than just giving money? Let's find out."

That worked so well I'm going to announce another kind of charity I'm looking for. As I've mentioned before, I'm fairly privileged, and sometimes when that privilege manifests I like to mark it with a charitable donation. I funded someone's dental care after my gum infection was removed, and a move for a job after I got my shiny new job. I'm feeling that urge again, this time because I paid $35 for antibiotics that cost four figures retail, for a relatively minor problem. I don't know if minor is the right word: it's another gastrointestinal ecosystem issue, so fixing it will have huge cumulative effects on me... but no where near the effect $1100 worth of penicillin could have for people who can't afford it. I don't know how to mark this one. No one goes to Modest Needs for antibiotics alone, and funding other health care, while obviously a very good thing, doesn't feel right in this particular case. Many years ago I read about a charity that pushed/facilitated hospitals to follow some very simple checklists that led to huge improvements in patient outcome. That felt right, but I can't find it now.

Hell, last week my boyfriend spilled bacon grease on his hand, and would have really liked to have gone to the hospital, but had neither the money nor the insurance. $1100 to enable that would have meant more to him psychologically than these antibiotics do to me, even though our home care worked fine. This time. I want to give someone else the gift of not worrying about it. That is why the checklist charity felt right: it's emphasis is on reducing the executive function needed to get the best outcome. But I just spent 10 minutes googling and found the initiative I was thinking of, but not the charity.

Taking another tact: Those antibiotics are supposed to help me digest food slightly better. Let's phrase the goal as "maximize number of nutrients digested." In that case, just giving people food is helpful. There are lots of charities to give people food. I will find a good one of those and donate.
pktechgirlbackup: (pktechgirl)
The surprisingly socially aware Cracked has an article on stupid habits you develop being poor. I had two thoughts when I read it: One, that's not about low income, it's about volatile income. Two, that's perfectly describes what I do with whatever you want want to call the combination of energy and focus that allows me to get anything done, ever.

I really, really identified with the feeling that whatever you do, you're going to end up tired (broke) again soon, so you have to spend this energy (money) as soon as you can. There's no concept of prioritizing because that will slow you down, and no concept of saving because it never seems to stay saved. Logically I know that can't be how it works, but my energy levels seem so exogenously determined that it breeds learned helplessness.

This suggests that ADD meds are useful beyond their primary effect of giving me energy. By providing a chemical reassurance there will always be energy, they create an incentive to use it carefully, the same way a guaranteed income could (theoretically) improve quality of life through increasing stability without costing much.

While we're using financial metaphors for health issues, let's talk about debt. I had a huge amount of physical and emotional debt stemming from a lifetime of malnutrition. Depending on how you count I started trying to pay that back 3 years ago (with cortisol and an artillery of vitamins) and started doing so effectively nine months ago (with HCl, and some vitamins). In many ways food/nutrients felt a lot like money and energy, in that my gut believed every morsel could be the last, and it needed to be spent as quickly as possible. This worked better than you would think, because my body listens to Dave Ramsey and its panicked spending took the form of paying down debt. It's not always the optimal thing to do, in health or in money, and I may not always have picked the optimal debt to pay, but it helped some and there was no chance of making myself worse off.

But I think that recently I paid off that debt, and am ready to start investing. The problem is that bodies are like old-timey economies; there's no bank that is happy to accept exactly as much money as you have for arbitrary, unspecified periods of time. There isn't even a mattress to store nutrition under. Either you invest it now, or you let it go. But investing takes commitment: if you get halfway through a project and run out of money/nutrients, you've not only lost everything you put in, but probably more besides. Potentially a lot more. And then once it's built, you have to maintain it. You'd be stupid to build anything unless you knew you'd continue to have the income to support it.

While I was in debt I could get away with throwing vitamins around haphazardly, knowing there was some decrepit organ somewhere that could be propped up with them. Now that I'm out of debt, I have a much more difficult task: convincing my body the nutrients will keep coming forever, or at least until the new structure has paid for itself. This is a very different challenge.

PS. I would like to state for the record that however challenging my medical issues have been, there are lots of people who have it as bad or worse in addition to being poor, and that is a lot harder than what I lived through.
pktechgirlbackup: (pktechgirl)
The Vyvanse got less and less effective as time went on, and it was impossible to tease apart how much of that was physical acclimation, how much was psychological, and how much was the additional strain from gastro-intestinal ragnarok. Now that the stompocolypse is over, we can better analyze.

First, it did not go quietly. I finished on 10/30. But that was just the stomach/large intestine apocalypse. My doctor has been on my back to do a test for the small intestine since we met in May, but it involves both several steps and fasting and I don't cope well with either of those things. But I wanted it done and I was already taking a long weekend for Samhain and I decided to just do it, and the agony it induced justified time I've ever pondered fasting but decided I couldn't do it. I was very literally shaking by the end of it. That was Saturday morning, and I spent the rest of the weekend recovering. I also took the weekend off from Vyvanse as well, and then started my new, higher dose on Monday.

Here is what I have noticed so far:

  1. Even with the raised dose, it is not quite the magic of my first few days on Vyvanse. That is unsurprising but still disappointing.
  2. Despite the lack of super powers, the dose is high enough to disrupt my sleep. That's well within expected parameters and it may well dissipate, but I miss the time when everything was wonderful at no cost.
  3. And by no cost, I mean no side effects and a nominal amount of money from me. I looked at what Vyvanse costs retail and Jesus I have amazing insurance.
  4. It appears to cost the same no matter what your dose is. Maybe they don't have to worry about pill splitting for schedule II drugs? It annoys me that the FDA has defined any variability in how much I take in a day as fraud of one form or another.
  5. I've stopped using the HCl pills, but use a lot digestive enzyme pills.
  6. My aversion to protein and ravenous desire for fiber that came in the last days before gastromaggedon haven't changed much. I'm nudging myself to eat protein, but it's hard going. What I really want is fiber. All the fiber. Soooo much fiber. I feel like I'm trying to slow down the food in my GI tract.
  7. I stopped wanting junk food about halfway through stompocolypse, and that's stuck around. It has been replaced with a desire to eat all the grapes in the entire world. Grapes have fiber.
  8. Also, for some reason, salmon, which work has steadfastly refused to provide me in the quantities to which I wish to become accustomed. Of course, I was done with salmon after two pieces of sushi, which is not so impressive compared to that entire bag of grapes I just ate.
  9. Between the slow release meth and the four horsemen moving through my stomach, my adrenal glands (never the strongest) were shot. I was really afraid I had pushed myself back to where I was in 2009, and wouldn't be able to keep taking the pills that make my brain actually work. The fear is bad enough I am just assuming that if my doctor AND the lady at the health store both this completely untested herb will help, it must be true.
  10. After three days off I'm feeling a lot better. I was already planning on one dark day a week, I might up that to the entire weekend, at least for now.
  11. Two medical professionals have commented I just look healthier. It's possible they're confusing healthier with thinner (I'm down 25 pounds from June, which is 5 pounds below what I think of as my set weight), but I'd believe my skin and constitution look better too. Maybe I don't look quite so overwhelmed all the time.
pktechgirlbackup: (pktechgirl)
You could be forgiven for thinking that getting "The HPV Vaccine", or worse, "The Cervical Cancer Vaccine" means you will never get HPV and/or cancer, because that's what a lot of news coverage has indicated, and because public health workers tend to overpromise and obscure details in order to motivate. The truth is that there are many strains of HPV (NIH says >100), there's no reason to believe our list is comprehensive, and a vaccine against one is not necessarily effective against another.

That's okay. HPV is incredibly common, to the point that some scientists think some strains be commensal. That makes it hard to prove what it's effects are: does increased prevalence of strain in renal patients mean it causes renal disease, that it's harmless but increases in prevalence in response to renal stress, or that it's harmless in healthy patients but harmful in the quantities seen in renal patients?

What we can agree on: some strains cause warts. Warts won't kill you, but they can hurt and create a vulnerable point other infections could use. How bad is that? For a modern American who wears shoes all day, plantar (foot) warts are more likely to harm you through bad ergonomics than an opportunistic infection.* If you are poor and shoeless in a sub-saharan Africa that vulnerability is a really big deal. Genital warts make it easier to catch another STD, but the exact probability HPV leads you to another STD you wouldn't otherwise have caught depends on the STD status of the people you have sex with.

We also agree that HPV can cause cancer. You can't prove it's impossible to get cervical cancer without it, but it's probably safe to say that if you do so you've either been storing nuclear waste in your vagina or severely pissed off a vengeful deity. Now that we're looking for it we're also finding certain strains associated with penile, rectal, and oral cancers.

Given that there are a large and growing number of identified HPV strains, some of which might even be beneficial**, and each strain must be separately cultured, increasing expense how do you decide which to vaccinate against ? When making Gardasil, Merck chose four strains, two of which caused 90% of genital warts, and two of which caused 70% of cervical cancer.

Or did they? New data is out suggesting that the vaccine is less useful in black women than white women because black women are more likely to have strains the vaccine doesn't cover. Some people are describing this as "less effective in black women", but that's misleading. As far as we know the vaccine is equally effective against the strains it claims to be effective against*** on a biological level. It's just not useful because black women are much more likely to be exposed to strains the vaccine doesn't protect against. By far the simplest explanation is that whatever study generated the prevalence estimates oversampled white women.

This demonstrates a couple of things. One, the importance of sampling across the entirety of the population you want the data to apply to even if you are really, really sure they're genetically identical. I would not be at all surprised to discover geographic differences in strain distribution. But if I'm correctly interpreting this newspaper article with no link to the underlying study, participants were recruited at the same site and so roughly the same geographic area. Assuming no racial influences on susceptibility or response, this suggests that white and black women, and their partners, are swimming in entirely separate sexual pools.

I'm not that naive. I knew people tended to have sex primarily with same-race partners. But my epidemiology intuition says it shouldn't take *that much* cross over for strains to reach prevalences much closer than what's being reported here, because once a strain has crossed over, it should rapidly colonize a wide open pool.

Alternate possibilities:
  • exposure to one strain makes you resistant but not immune to another, so which you strain you have is correlated much more heavily with early sexual partners than later ones. Without looking it up I'm pretty sure people's first partners are much more likely to be the same race as them. This suggests that the wrong-strain vaccines are still likely to be some helpful, but not as helpful as the right strain.
  • People who engage in interracial sex are atypical in their engagement with their own race. They might have fewer partners, observe a higher standard of sexual safety. or have sex nearly exclusively with members of that race, making them part of that cluster.
  • the true clustering is around a factor other than race but with a heavily non-random distribution, like location or SES.

    *True story: the only time I've ever used crutches is after having a plantar wart burnt off.

    **Commensal is defined as one side (HPV) benefiting and the other side (humans) receiving no benefit. However, if harmless HPV is taking up space on our skin that would otherwise be occupied by something damaging, that's a benefit, like those spiders that avoid humans and eat black widows. Or the HPV could be involved in some weird but ultimately beneficial cycle with the bacteria on our skin. We don't understand the ecosystems within our own bodies at all, and our overconfidence at what can be safely removed has caused a lot of trouble over the years.

    ***Never say never, but I'd be shocked if the per-strain effectiveness differed significantly between races, because even if there was a genetic component, race is a stupid categorization that tells you very little about an individual's genetics.
  • pktechgirlbackup: (pktechgirl)
    It turns out that it was not so much illness affecting my stomach as my stomach affecting an illness. I mentioned an attempt to treat my digestive problems as an aside to my Ode To Vyvanse, but three weeks later the stomach treatment is a much bigger influence on my life. The treatment could best be described as "we had to destroy the village in order to save it." The weapons may be particularly effective against H. pylori and my mystery parasite, but mostly we are rooting out everything so as to leave my stomach an empty canvas, on which we can paint the ecosystem of our choice.

    This was all going fine (module moderate cold-like symptoms) until my two week check up (it's a 30 day treatment), when I told my doctor things were going fine, and she upped my dose significantly. Now I have a lot of gastroitestinal... not pain, but ickiness, discomfort, and nausea. My cold symptoms are alleviating only slowly, and the nausea gets much worse if I'm in a moving vehicle. I'm back to not really being able to digest protein, even with *a lot* of pills. I went through $40 worth of digestive eynzymes in 4 days.

    For a while I was treating this with Pepsi, but ginger tea has supplanted it. Unfortunately the loss of caffeine plus inevitable attenuation to the Vyvanse means my ADD symptoms are returning. Not as bad as they were, but enough that they're a burden.
    pktechgirlbackup: (pktechgirl)
    My digestive system and my immune system are at odds, and it is annoying me.

    My immune system hates wheat, milk, and eggs. If I eat them, my lymph nodes swell and I feel generally sluggish and icky.

    I don't produce enough digestive enzymes. If I don't supplement with HCl and digestive enzymes, eating anything with real nutritional value, like vegetables and meat, makes me feel ill. I can feel it sit in my stomach and rot. In my stomach's ideal world, I live on bagels and pasta, but of course that is not good for anyone, and is especially bad for people with wheat sensitivity.

    I'm sick. My digestive system is even more sluggish than usual, to the point that real food makes me feel icky no matter how many pills I take. My stomach could handle small amounts of simple carbs- but my immune response to wheat hasn't gone away. There is nothing I can eat that will make everyone happy right now. The compromise has been marshmallows and dark chocolate, which are are easy calories that are nonetheless gluten free. You can tell my nutritionist is cool because she said that was not an ideal long term solution but a perfectly good way to cope with the situation at hand.
    pktechgirlbackup: (pktechgirl)
    The only negative side effects I've had so far are a lightheaded feeling (which be a sinus issue), drinking a lot of water, and mild diarrhea (which could have been caused by the new digestive system treatment my normal doctor gave me, which I started at the same time. it's not an idea experiment, but I wasn't willing to wait on either). Of those, only the water consumption is still around.

    Unexpected positive side effects include significantly reduced back pain and needing dramatically fewer magic food pills (could be the digestive treatment, although our initial guess was that that would make me temporarily need more).* I still enjoy r/trypophobia a great deal, but r/AdviceAnimals is just stupid. When browsing article-heavy subreddits, I actually read and appreciate the articles and don't feel an internal clock to get back to reddit itself.

    The Vyvanse very definitely wears off. It's startlingly obvious if I'm doing job-work at the time, but I can eventually tell even if I'm doing something lighter. Vyvanse is well known to cause sleep disturbances, but in my case the only problem is that it isn't present to prevent late-night internet fuckery cycles. Once I break out of those, I fall asleep just fine, possibly even better. And yet I'm waking up earlier, and engaging in less phone internet fuckery before hauling my ass out of bed. To be clear, I am more awake and focused and able to act before I have taken the pill. Either some of it is sticking around overnight, without disrupting my sleep, or whatever system let me get anything done before is able to do a better job now that it's not bearing the weight of the entire world. And even the late night internet fuckery cycles are a little more focused and a lot less facebooky.

    I still haven't had a full day in a room with the co-workers with no indoor voices, but I did go to a convention hall full of screaming children yesterday. Given the choice I would have done without the screaming children, but their presence felt more like a tax on my enjoyment and less like an overwhelming assault.

    Part of me thinks I could do with a higher dose, but my stomach says that would be pushing my body too hard right now. I need more protein. And now I have the wherewithal to make that happen even on days work is not feeding me. And by "make that happen" I mostly mean "ask my boyfriend to cook for me", but that is still one more step than I was managing previously.

    This was a triumph/ I'm making a note here, huge success

    *Digression: my doctor's hypothesis is that I have an infection of H. pylori, best known for causing ulcers. There are two tests for H. pylori, and I tested positive on the less conventional of the two. I also tested negative for every known parasite but there is some DNA in my poop that should not be there, so I maybe have a parasite. The conventional treatment for H. pylori is massive doses of antibiotics plus a proton pump to raise stomach pH. It's an apocalypse for your digestive ecosystem and doesn't have a very high success rate. There is no conventional treatment for bonus DNA in your poop.

    My doctor (ND, not MD) has prescribed some pills with herbs and spices in them. A cursory search on google scholar indicates that people have in fact studied these spices as anti-H. pylori agents, but the studies are small and the results are mixed. It's still fewer side effects than the conventional treatment, so I might as well give it a shot.

    Given that magic food pills work by lowering my stomach pH, and part of the treatment is raising it, my doctor warned me I might feel really icky for a while. I delayed the start such that I'd be finishing the 30 day treatment on Samhain. We'll never known now, because I happened to get into my psychiatrist on 10/2 and I was not going to wait on the Vyvanse in order to let the secret recipe pills work in isolation.
    pktechgirlbackup: (pktechgirl)
    I've been on stimulants of some sort twice before- cortisol for hypoadrenia (I spent the first night vibrating like a hummingbird and didn't eat or sleep a week and then it was pretty much like normal except I could wake up in < 2 hours) and suadfed + armor thyroid + cortisol (doctor said it was okay, but three hours pacing around the office followed by collapsing under my desk say she was wrong). Vyvanse doesn't feel anything like either of those, or the jittery feeling my doctor warned me I about. I do not feel sped up at all. There is a mild lightheaded feeling, similar to after a good workout, and my back has a lot less pain and tension.

    I was way more productive at work today, but I was also much, much happier. I could actually stick to what I was doing and produce something. I don't even want to look at facebook because it's so noisy. I didn't put on music all day either. It's easier to get into pleasure reading. Even when I was taking a break, I stuck to one thing a time rather than jumping back and forth.

    But the biggest difference is that a problem I didn't notice I had is now gone. It used to be any time I had a thing I wanted to do (say, code a thing that does a thing), and it took a second or a step longer to complete than I thought it should, I'd feel like a failure. It should be done, why is it not done, it's not done because I'm stupid. It was the GTD loops theory, that your brain doesn't understand the concept of "working on", it just knows what should have already happened. But I only felt that while I was working on the thing I needed to do- there is no deadline or end goal to reading tvtropes, so I wasn't failing at it.

    Things like e-mail or even facebook used to give me a little productivity ping, which was awesome. Real projects never gave me that on account of the constant low level feeling of failure.* I haven't done the exact math, but it feels like I'm getting the exact same number of local productivity hits as I was before, but now they're in a thing I actually wanted to produce. I think this explains some of my compulsive phone use in meetings- the second we weren't making progress towards The Goal I had to go find something I could Accomplish, even if that thing was liking a picture of a cat in a boot.

    I haven't tested it with the co-workers with no indoor voices yet, but other people and their associated noises felt easier today. Exchanging mandatory pleasantries no longer feels like people are stealing from me. My ability to sit still and connect with my body** has gone up, which is pretty much the opposite of what I expected. I'm naturally more aware, and I can connect and listen deeper without feeling overwhelmed.

    It's supposed to be a 12 hour pill, but it very clearly starts wearing off around 8 hours in for me, and is gone by 10. Suddenly everything is hard. I'm back to fucking around on the internet. Nothing sounds fun.

    *A friend of mine more or less banished the sims from her life for this reason. It's major selling point was a quick hit of productivity. Do you know when that is most fun? When there is a large, unpleasant but mandatory thing you are avoiding.

    **not a euphamism for masturbation


    Oct. 3rd, 2013 08:12 am
    pktechgirlbackup: (pktechgirl)
    Long story short: I started treatment for ADD yesterday*. I've joked about having it for over a decade, when I went to a psychiatrist it was high on the list of possible diagnoses, but for a while it looked like the magic food pills would cure it (it being a lot easier to focus when your body isn't constantly on the edge of starvation). Recently, that hit a wall. Why this happened is an open question. I initially blamed the open office, but I've been in it for months. Psychiatrist suggested it was a side effect of all the dietary + digestive improvements I've made recently- that there's a mass die off of the bacteria that thrived under the old regime, and that this is stressful for everyone but especially for me because of my bad copies of the MTHFR gene and also I was starving for 25 years, and that one possible side effect of this is worsening sound sensitivity and less executive function. On one hand, this sounds like the kind of bullshit naturopathic practitioners use to explain away anything they don't want to deal with. Sort of an eastern "it's stress." On the other hand, I did start spontaneously sucking down massive quantities soda after three months of not missing it.

    My doctor's attitude on the whole ADD thing boiled down to "yep, those are a lot of symptoms. Take these pills and see if it helps. If it doesn't we'll try something else, if it does keep taking them, but stop every once in a while to see what happens."**, which is exactly what she would have said if she didn't suspect ghost bacteria were causing the problem. I like this doctor

    Yesterday was day one of taking Vyvanse, which is in the same family as Ritalin and Adderall (ampthetamine salts), but more on a more gradual release schedule, which makes it both more effective therapeutically and less useful recreationaly. My observations so far:

    • it's significantly less powerful than cortisol, in that I'm not vibrating my leg while quietly saying "zoom zoom zoom" under my breath for minutes at a time. There is sort of a lightheaded feeling, but I'm not jittery.
    • The DEA has arranged a catch-22 so archetypal they should be congratulated and then hanged. Schedule II prescriptions can not be phoned in, you have to physically pick them up. That's okay, because for the first few months I have to see my doctor every 30 days anyway. Eventually she will be allowed to write me Rxes for three months at a time. But not one Rx with two refills- three different pieces of paper, which cannot be given to the pharmacy ahead of time. Because if there's one thing ADHDers are good at, it's not losing things they won't need until a month from now.
    • I am typing very fast.
    • Frustrating work things have not magically become easy. I am not even focusing on them for any longer than I was before. .
    • OTOH, I went 7 hours without checking facebook or my non-work e-mail.
    • I am drinking a lot of water. Hard to tell if that's a dry mouth, responding to dehydration, or I'm newly able to sustain the focus to get water refills.

    I don't know whether I have a serious problem that I have mostly been able to mitigate with substantial gifts (primarily in the raw intelligence department), at the cost of a lot of hidden pain, or if I'm buying into the pharmaceutical-industrial complex's idea of what a worker should be, and drugging myself to uphold their ideals when what I need to do is simplifying my life. On one hand, I have wonderful friends and a job that is so much better than what most people have that it, in a statistical sense, doesn't exist. I'm not, Hyperbole and a Half style paralyzed by ADD. I'm not wetting my pants because I can't focus long enough to get to the toilet. I'm not the friend of a friend whose ADHD rendered him unfit for any employment beyond target. For fuck's sake, I graduated from one of the most difficult universities in the country with a double major in two of their hardest subjects.

    On the other hand, I'm functionally incapable of feeding myself anything that takes more than 2 steps, the only reason I don't have a Bernard Black style meltdown when asked to mail a letter with a stamp is that I don't have the energy, and I job-hop at a rate that would be prohibitive in any other field. My social interactions are significantly hindered by the fact that I react to boredom like most people do physical pain- and oh, the fact that they actually are painful due to the misophonia, which is entangled with attention issues. I feel like I have a lot of potential that is twisting in on itself until it chokes, and that is not the same as feeling like I'm disappointing my corporate overlords. I don't need to be as severe as any of the examples in the previous paragraph to benefit from help. How I did at school 10 years ago does not negate how I am doing at work now.

    So I will take the pills and see how it goes. They will probably be less revolutionary than the magic food pills, but maybe they will help.

    *ADD technically doesn't exist anymore, it's been rolled into ADHD. But I'm not hyperactive, and my symptoms best match inattentive-ADHD, which I am considering renaming to "AHDH for lazy people".

    **This is pretty much the only psychoactive medication for which that is a good idea.
    pktechgirlbackup: (pktechgirl)
    Doctor switched me from Halcion (which is what the periodontist gave me) to Xanax to keep me from having a meltdown in the dentist's office, because it's the one she's most familiar with. This proved to be a mistake, as Xanax mostly suppressed my mechanisms for coping with fear and pain. It also left me groggy and useless for >12 hours. In contrast, Halcion starts wearing off before I leave the office. Have left a message asking to go back to Halcion. On the plus side, if you tell the hygienist "I'm on too much Xanax for small talk" she will stop asking about your job.

    Dentists spent years and years yelling at me about my homecare and saying it would stop hurting if I did it consistently enough for long enough. It never stopped hurting and my teeth never got better. Than I went on the HCl for hypochlorhydria and my oral health immediately got vastly better. This has made me pretty fatalistic towards the concept of flossing. Plus I'm reading another book on Scientology, and "you only feel pain when you do this because you're not doing it good enough" totally sounds like something they would say.

    As I was walking to the dentist I realized I needed to give another donation to Modest Needs, but tracking down a dental case didn't feel quite right. When I checked my email afterwords there was a mass mailing saying that Modest Needs had depleted its emergency fun and needed more money. I didn't give them as much as they asked for, but donating to the emergency fund felt right.
    pktechgirlbackup: (pktechgirl)
    You'll notice a rather cryptic "Yet" at the end of my last post. At one point the idea of grabbing extrovert privilege for myself would have been anathema. But over the last few weeks there have been several times I felt the feeling I describe as "introverted out", yet really wanted to see specific people. I had to hold myself back because I knew if I went out I would disengage and everyone would be miserable, but that that was an intellectual understanding, not a gut level call for hibernation.

    I'm coming to the conclusion that I was not sick of people, I was in sensory overload, and people happen to be highly stimulatory. This would explain why I keep telling people I'm going to relax by playing video games and then spend four hours doing a puzzle, and why I kept "wasting" my bus commute just listening to music instead of efficiently watching TV, or at least listening to a podcast. It explains why my misophonia has been worse lately, to the point I'm wearing earplugs to meetings and I don't even care if my co-workers think I'm weird. It explains why I'm intensely picky about touch some times but not others.

    These explanations aren't exactly antithetical- there's a lot of evidence that introverts find life in general and social interaction in particular more stimulating than extroverts (which is why extroverts are more likely to have adrenaline-junkie hobbies, and introverts solo hobbies trend towards the quiet). And I've undoubtedly had genuine needs to introvert in the past. But trying to recharge these last few weeks felt like trying to force in a peg that wasn't quite fitting, and now it feels smooth. I feel more true to myself, and more hopeful about finding ways to make myself happy.
    pktechgirlbackup: (pktechgirl)
    At the end of June, my doctor advised me to drop milk, eggs, wheat, yeast, and some miscellaneous produce. I was...against this. it was based on tests (igG response) that produced pretty graphs, but the test seemed to be unerringly detecting the foods I actually ate. And it turns out that the test is pretty controversial, with my friend's allergist telling her that it did exactly that, and my naturopath (and hers) saying that it detected actual problems. But I decided to give it a shot. I would eat whatever I wanted until the fourth of July weekend (which gave me five days), go through the inevitable withdrawal over the four day weekend, and then commit to it.

    My reaction has been... weird. First, even though I gave myself permission to eat whatever I wanted in those interstitial five days, I didn't use it. I kept going with eggs at work in the morning because there was rarely a better option, but without even thinking about it the others started dropping out.

    I made a few rules: one, I would not accept substitutes- no cookies made with rice and vegetable oil. If I was going to give these things up, I was going to embrace what I was eating instead, not taunt myself with inferior substitutes that were quite likely to cause the same problems anyway. Two, I was not going to be afraid of food. Work very helpfully labels food with potential allergens, and I could control what I ate at home, but if I was at a restaurant I was not going to worry about trace contaminants or interrogating the restaurant staff.

    My reaction was heavily bifurcated. Once I gave the foods up for good, I didn't want them. Or rather, my brain missed them. I had a memory of wanting them very badly. I bitched endlessly to my friends about the things I couldn't eat. I hated having to tell myself no. I lost ~five pounds over a month. I'm probably not getting enough protein, because I'm still slowly ramping up my meat consumption. But my body did not want any of the banned foods. It was inconvenient to eat nothing but meat and produce, but that was about it. I hadn't noticed a huge physical change, but I my chronic low level heartburn did dissipate.

    The mental cravings increased, to the point that I *dreamed* about cheating. I decided that I could break the rules for feast days, especially for emotionally significant foods. My birthday is coming up, and my !boyfriend cooks, so I concocted a plan in which he would make me ice cream cake and I would have pizza, which is how I celebrated birthdays as a child and also Samhain two years running.

    I did not make it quite that long. The day after I dreamed about ice cream, I had an early birthday dinner with my best friend, and decided that since it was A birthday celebration I could get crab wontons. I crashed afterwords, but that could mean anything. The interesting part is that a few hours later, my lymph nodes swelled up, and they still haven't gone done. And now that I noticed, I remembered that they used to be chronically swollen, and that must have gone away at some point

    I'm not going to cancel my birthday, partially because one day is not conclusive and I need more data, partially because I couldn't stand to see the look on the boy's face if I told him I didn't want his cake anymore, and partially because ICE CREAM CAKE. But if this pans out, I think the food sacrifices are going to stick around.
    pktechgirlbackup: (pktechgirl)
    I have trouble getting out of bed. Depending on when I have to be at work, it can take anywhere from twenty minutes to three hours for me to go from conscious to actually getting up. Followed by several more hours of me dragging around the house. That + anxiety symptoms* were enough to almost get me diagnosed depression. Unless it was an adrenal problem. No one really knows. Then I found this image.

    Caption: "If you wake up super early after a night of drinking, it's because your blood sugar level is low. Eat a piece of bread, or a spoon full of peanut butter. It will spike your insulin levels, and you can go back to sleep"

    Let me tell you a few things about this image:

    • It originally appeared on the Advice Animals subreddit

    • it's advice from a duck

    • The duck does not appear to understand the difference between blood sugar and insulin.

    As soon as I saw it, I knew it had the answer.

    I wasn't waking up because I was done sleeping, I was waking up because my blood sugar was cratering. Which, despite waking me up, also makes me tired and slow moving. So I've started keeping snacks on my nightstand, and what do you know, I now either fall back to sleep or genuinely wake up. Interestingly, the last time I took food the very second I woke up was when I was taking cortisol for adrenal fatigue, because the cortisol helped me get up and it had to be taken with food. In retrospect, I wonder if the cortisol was getting undue credit for work done by food.

    And that's how I gave up caffeine.

    Other interesting news: my core body temp has gone up half a degree, relative to before I started taking HCl supplements.

    *Now known to be caused by me slowly starving to death
    pktechgirlbackup: (pktechgirl)
    If you watch videos on youtube of soldiers greeting their kids after a deployment, you'll notice their first reaction is always crying.

    This is pretty much me and food. I'll be happy to be eating eventually, but right now it's all realizing what I've been missing. For example, I always assumed it was normal to barely be able to hold back tears when food you expected to be there is not there. I am beginning to think that "counting on that yogurt" is not a thing for most people.

    I've always regretted... well, not a lack of travel on my part, more the absence of desire to travel. All the cool kids want to go to these cool foreign places and my idea of a vacation is a weekend in a cabin with comfort food and no people. In retrospect, this is because vacation offered a million ways for me to potentially starve to death. Regimented meal times. Having to negotiate with other people over when and where to eat. Having nothing I can eat, or having only one thing, and everyone notices I eat the same thing every night. Far more planning required to reach optimal snacking. And that's American travelling. Going somewhere without a McDonalds on every corner might have caused an honest breakdown.

    it's also had a pretty profound impact on my ability to socialize, given that so much is riding on where we choose to eat and I am pathologically incapable of participating in a restaurant discussion with >3 people when I'm hungry, which is always. I hated being That Girl Who Only Eats Kids' Food (and also Pad Thai), so I couldn't advocate for myself. Really innocuous comments about what I was eating came off as highly threatening.

    it's weird, because what was scarce for me wasn't food per se, it was stomach time. My stomach had a much lower throughput than normal, so I had to optimize both timing and what food I put in. It left very little room for experimentation. And in a way, that hasn't changed, because while my throughput is much higher, there is so much nutritional debt to pay off that the old habits are still pretty plausible. So my diet has not expanded that much, it's just shifted to more of the old proteins I always ate, and more vegetables. My acceptance of new spices has gone up, but it is mostly the same vegetables.

    I don't think I can convey how important *familiarity* was, and really still is. One day work didn't have any safe/familiar vegetables. I improvised with carrot ginger soup. It was pretty good. I then ate six meringues, and I didn't feel safe until the sixth. I've compromised on my junk food habit, in that I still eat it, but when I do I take some vitamin I feel I'm short on as well (accompanied with magic pills), which now that I'm typing it looks like another manifestation of stomach time as a scarce resource.

    I feel safer being around food. I'd rather eat in the cafeteria than go outside no matter how nice it is. I grab extra food at breakfast and keep in on my desk. Sometimes I eat it, but I just feel safer having it on my desk.

    About 4 seconds after I notice I'm hungry, I'm almost shaking with it.

    On a physical level, I'm having astonishing amounts of muscle fatigue. My aerobic capacity is shit. Usually I'll walk even if I'm in a lot of pain, but I'm honestly contemplating elevators right now. It's deeply counter intuitive and I've asked my doctor about it. My crackpot hypotheses are that my temperature has gone up with my base metabolism, or the presence of vitamins has increased demand for protein beyond the amount my intake increased.

    My acupuncturist brought up quitting wheat, he thinks the gluten is doing bad things for me. My reaction at the time was very defensive; that no matter what physical damage it was doing, the mental and emotional damage of giving it up would be worse. People have always been telling me to give up wheat, and until just now, that would have been devastating because I couldn't eat all those "better" food they wanted me to. I wanted me to. This makes wheat sort of like that friend who is really an asshole, but was there for you a few times when nobody else was, and their current behavior is seriously not okay but you feel like a jackass ditching them now that you have better options.

    SMBC had a comic about using wishes to fix critical mistakes in your past, and I keep thinking about how my life would have been different if I could go back and time and tell my parents their daughter needed a single vitamin and everything would work out fine.
    pktechgirlbackup: (pktechgirl)
    I've talked before about how I hate how modern/Western medicine focuses on treating symptoms rather than root causes, and in particular ignores nutrition beyond some vague food pyramid that is based primarily on who gave the most money to senators on the right subcommittee. So I went a doctor that actually listened to me as a whole person, and focused on nutrition as a fix for them. Initially in pill form, but hoping to transition to real food eventually. Only that never happened. It helped (I have more energy and didn't get sick at all last winter, as opposed to my usual average of "all winter"), but only temporarily. I was taking more and more supplements until I just gave up and stopped all of them. One would work for a while, and a different problem would crop up, and it just felt like symptom whack a mole. I couldn't go 90 minutes without eating without feeling awful, I'm eating mostly hyperpalatable crap and have to bribe myself to get through a meal with protein, which I nevertheless find incredibly stressful. I don't understand why I freak out if food doesn't taste good, why can't I eat for nutrition like everyone else?

    Five weeks ago I went to a nutrition-focused psychiatric ANRP about a possible anxiety disorder. She listens to my symptoms, including the supplement whack a mole, and suggests I have low stomach acid (hypochlorhydria). Dr. Internet tells me there's a fancy test for this involving swallowing a pill containing a radio transmitter and some sort of pH meter, which I kind of want to do just to have a tiny science lab in my stomach, but the ANRP just told me to try taking the treatment (pills containing stomach acid, plus pepsin, an acid-activated enzyme for digesting meat) and see if it helps.

    Oh. My. G-d.

    Now that I know what it's like to *not* feel ill after eating food with protein or fiber, I can recognize that that's what I was experiencing before. I felt deeply ill any time I anything with real nutritional value, but was pushing my awareness of it away because I couldn't deal with it. Or I was sucking down soda because it was the only way my body could ask for more acid. It also explains:
    • Why I could feel like I was starving and disgustingly full at the same time
    • Why I have always felt so food insecure even though I've never been more than a car ride away from all the food I could ever want.
    • Why I've always been such an insanely pick eater, and found trying new foods so stressful.
    • Highly suspect this has something to do with my salt addiction
    • Why I became a vegetarian at age 6 in a house full of meat eaters.
    • The fascinating variety of subclinical hormonal disorders I have and the fact that curing one just leads another one to pop up somewhere else.
    • Why feelings of fullness were more dependent of food temperature than volume or nutritional level.
    • environmental allergies

    Clearly I was able to extract some nutrients because I'm not dead, but I'm honestly not sure how. I'm still working out the exact dosages, but I easily take 200 pills in a week, where the bottle says 1 - 2/meal. I needed 180 mg just to eat a pear. I haven't even been counting how many I'm taking with this protein shake I'm drinking right now, but it's more than 1 gram of betaine HCl per gram of protein. ARNP hasn't ruled out a bone fida anxiety disorder yet, but that's only because she hasn't talked to me in three weeks. It is abundantly clearly to me that the actual problem was the psychic load of feeling that I was going to starve, and borderline malnutrition.

    There's a few lessons I want to draw from this. One involves an Inception joke about going deeper: I thought I had found the ultimate problem by taking nutritional supplements, but never looked at why I had a deficiency. The second is that gastric bypass can easily induce hypochlorhydria because it cuts out the acid producing section of the stomach, so don't do that. The third is about will power. I, and others, constantly beat me up over my poor eating habits. I felt really ashamed that I had so many problems. And I suppose things might have been slightly better if I'd powered through the nausea and fatigue and blood sugar induced bitchiness and eaten perfectly anyway, but I wasn't doing those things because it would have left me miserable and friendless and quite possibly unemployed. The problem was not lack of will power or moral fortitude, it was a g-ddamn chemical.

    The fourth is that I can eat 12 Wendy's Chicken Nuggets without needing a single pill, and I think this tells you a lot about the food content in fast food.
    pktechgirlbackup: (Default)
    My dental surgery was originally scheduled 5 weeks in advance. The pain got worse, they gave me antibiotics. The pain still got worse. It felt like biting tinfoil, which meant whatever it was was interacting directly with the nerve. This would make me nervous if I didn't already have a broken oral nerve. The periodontist agreed to work outside her usual hours to fit me in in a week (three weeks earlier than scheduled). The pain did get better, but it came in waves and I decided I didn't want to reschedule again, so I didn't tell them. The surgery was today.

    In many ways, it was the best possible outcome. 30 seconds after cutting (just long enough to clear out the pus), she found aberrations big enough to cause the problem, but no bigger. There was a sliver of broken tooth, presumably left over from my wisdom teeth removal (which was over four years ago), and a lesion that is assumed to be a bacterial cyst unless the biopsy says otherwise.* The lesion was within a few millimeters of the nerve, but not touching it. This is good, because if it was on the nerve my choices would have been nerve damage or never clear the infection.

    I don't have good data on this and the doctor was patently uninterested in playing what-if with me, but it certainly seems plausible that the three weeks between the new date and the old would have been enough to grow the cyst all the way to the nerve. I already have nerve damage on one side and it's awful, I don't know what I'd do about both. it's entirely possible the reason this got so bad was that I'm so good at not hearing pain from my mouth that I didn't notice it. I know I didn't report it to the dentist at first because I was too fucking stressed out to deal with it, I just wanted to do the right thing and get my teeth cleaned and I'd deal with the chronic stuff later. If I hadn't gone in for the intensive cleanings, who knows when this would have been caught? So there's two paths that lead to nerve damage.

    I think this got treated faster in America than it would have in any other country. As I understand it (and good data is woefully hard to find), countries with national health care operate on a pretty strict queue system, and doctors have no incentive to work extra hours. I assume you can jump the queue if you can prove you have a more serious problem, but because the cyst was soft tissue it didn't show up on an x-ray; the only metric we had was my pain. While my periodontist believed me enough to reschedule the surgery, it was clear that seeing the size of the cyst** caused her to retroactively give my complaints a lot more credence. A queue that can be jumped by claiming more pain won't do it's job, so in an NHS world I probably would have been stuck with my original number, which undoubtedly would have been longer than the 8 weeks between my dentist popping the first (smaller, exterior) cyst and now. Socialized medicine could easily have caused me permanent nerve damage.***

    On the other hand, I only got seen and operated on that quickly because I have money. Lots of money. Enough money to see my dentist 16 times a year, to take the first available periodontist appointment without worrying about paying for it, to take the first available surgery slot without worrying about paying for it. More subtly, having and growing up with money makes it easier to have the entitled attitude that led me to tell the periodontist this couldn't wait. When I told (not asked) my boss I needed to move the surgery earlier, but this was better timing for the company anyway, he said "well, it really doesn't matter how the timing affects us, if you need it now you need it now." This exactly the sort of care you can make yourself believe doesn't need to be treated right away, giving the infection time to spread. People die of this.

    I prefer a market-based health care system not because our system is working particularly well, but because I believe it has to capability to improve in a way the NHS does not. This ability to change comes at a terrible price, and no matter how much money I donate to dental charities, I'm not the one paying it.

    *Me: so is there anything the biopsy could reveal I should be worried about?
    doctor: no.
    Me: Then why are we doing it?
    Doctor: something something best practice

    I assume that there is a small but present chance this is something awful, like cancer, and she doesn't want to have to talk to me about it until we have actual data. Which I'm sympathetic to, but I'm also pissed that I was being asked to decide whether this was worth my money and the cost of a false positive while I was under a quarter milligram of a benzoate, massive amounts of whatever local anesthetic they gave me (which does make me feel mentally weird), and the stress of surgery. This was a predictable outcome of the procedure and they should have asked me ahead of time.

    **Biggest she'd ever removed. She had to leave behind a plug so the gum tissue wouldn't collapse in on itself, any bigger and it would have required a graft.

    ***Possible relevant and even more frightening: antibiotics would not have fixed this. My cyst was that huge despite me finishing a course of amoxicillan a week prior.
    pktechgirlbackup: (Default)
    At the end of a 4 visit, $1200 dollar deep teeth cleaning sequence, we discovered I have a deep gum infection. My dentist is sending me to a specialist, who she predicts will want to do minor surgery to clean out whatever the source of the infection is. And while I'm deeply unhappy about this for many reasons, I am still secure in my ability to pay for it, and that is a gift.

    The thing is, I believe in the concept of exchange, and that relationships that are out of balance cause problems. My relationship with my dentist is totally square: I gave her money, she gave me use of equipment and her employee's time. But my relationship with dentistry-as-a-concept is deeply out of balance. It is offering me the potential for a longer, less painful life. I am offering nothing in return.

    The only way I can think of to fix this is donating to a dental charity, so someone else can benefit from the same level of care I get. I don't know why I think that benefits dentistry-as-a-concept in a way alleviating my own suffering does not, but I do. I looked around, and while there are dedicated dental charities, and free clinics that do dental work, none of them are big enough to be on charity navigator.

    At first, I rejected modest needs because none of the dental cases were the maximum impact kind- i.e. otherwise healthy young adult or child suffers from a single, uncomplicated issue that requires a one time grant to fix. They were all elderly, or disabled, or very sick. Funding their dental care has a substantially smaller snowball effect than removing someone's last big problem. But I think I was wrong about that, and was in some ways falling into the trap I discussed yesterday. The value of dental care is most obvious when nothing else is going wrong, but that doesn't lessen its value to people with many problems.

    As it happens, the first case on modest need's website was for partial dentures, and needed only $35 to complete.
    pktechgirlbackup: (Default)
    I can't speak to the inflammation side of things, but cutting out grains at breakfast has done wonders for me. I'm much more awake, and I've completely lost my desire for caffeine. Moreover, it puts me under critical mass for bee stings, such that I now notice when something delicious crashes my blood sugar and makes me take an unsatisfying three hour nap. This drastically lowers the amount of willpower required to make the long term good decision, because the payoff moves from "6 weeks, at a minimum, if I keep doing everything right, I might feel slightly better" to "There is a direct correlation between this action and the happiness of me 15 minutes from now"

    The resistance stretching is also working well. A walk that would previously have left me limping in nonspecific foot pain didn't hurt at all, and my back pain has moved from "well, something is definitely hurting in that region but it's too painful to investigate" to "that specific spot hurts". The pain spots don't actually follow any musculature or connective tissue, and I suspect that's a necessary step for it to stop hurting, but it is still a huge improvement.

    TQI diet

    Oct. 16th, 2012 12:43 pm
    pktechgirlbackup: (Default)
    My whole life, I've had issues with inflammation. Joint pain, inflexibility, allergies, dental pain, weak immune system. Treating my hypoadrenia helped, but we have reached the point where that is not the problem, or at least the old cure (cortisol supplements) will do more harm than good. So we're going to try diet, specifically the To Quiet Inflammation diet. Honestly, the description and testimonials look sort of crazy, and I'm suspicious of anything that assumes the modern American aesthetic ideal for body fat is healthy, especially given that all the evidence points to exactly the opposite. But someone I really respect said several people she respects had a lot of success with it, and I've exhausted the stock of things I thought were good ideas, and five weeks is a reasonable amount of time for the potential payoff. Even if it doesn't work, I can see the denial being an interesting spiritual exercise. So I'm giving it a shot.

    TQI has some principles you have to follow forever, but kicks off with an even more stringent elimination diet. I do not like my chances starting off with the strictest form of the diet, so I'm introducing phase 0, where I learn to cook according to the forever-rules, so that when I have to cut out a bunch of delicious, delicious foods, I will at least be able to feed myself.

    So my goals for now through Halloween are:

    • breakfast is 1/2-2/3 produce, with the remainder being made up with protein. No grains.
    • I am debating following the "no additional sweets" rule for breakfast, because I think honey is good for me.
    • Stop eating several hours before bed. I do this one naturally unless I badly screw something up. This may mean planning workouts better.
    • At least one meal a day where I'm not doing anything else while I eat.
    pktechgirlbackup: (Default)
    With my departure from martial arts, I have a lot more free time. More than that, I have more mental energy and schedule space than I have in years. The effect is bigger because last time I had this much free time I had a substantially weaker endocrine system.* It feels way, way more like getting out of a long term relationship than it should. I want to get out and try lots of new hobbies without committing to any of them. And unlike the relationship-equivalent, it's totally not tacky to document a hobby search in detail.

    Today I went to a circus arts class. There were five parts: acro, tightrope, juggling, trampoline, and aerials. I would enjoy being good at any of these, even tightrope, even though it doesn't look that cool and is really pretty painful. But acro and aeriel weren't really fun as an inflexible beginner. Juggling was fun, and might actually be a good flow state thing, but taking a class in it seems unnecessary and possibly even counterproductive.

    Trampoline was the clear winner. I grinned my way down the first tumble. It's entirely leg strength, which is my comparative advantage. More flexibility would be better, but trampoline didn't throw my limitations in my face like acro did. I'd consider a prolonged fling, but the only classes available would cramp my lifestyle, and I'm just not in the mood for making compromises right now. But worth looking at after I've sown some more oats.

    Next day update: ow the back of my legs. Which is great, because like most women that musculature is comparatively under developed on me. But it's weird, because karate hadn't had that effect on me in years. I think it's a combination of building up the relevant muscles and your body recognizing and avoiding this that will tire you.

    *For the curious: I'm off of all prescription drugs, still taking DHEA (cortisone precursor) and some normal vitamins. I'm not optimal, but I'm a lot better than I was, and at this point the drugs do more harm than good.


    pktechgirlbackup: (Default)

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