Today I Learned...

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.

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.

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.

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

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.

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.

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.

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.

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.

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.