Things They Should Invent: install stomach lining in the esophagus

Stomach acid is one of the most acidic things there is, but it doesn't harm the stomach because the stomach lining is strong enough to withstand it. However, it causes damage when it refluxes up into the esophagus, because the esophagus isn't meant to withstand stomach acid and therefore isn't strong enough.

Solution: come up with a way to line acid reflux patients' esophaguses (maybe just the bottom, maybe the whole thing) with stomach lining, so the acid reflux can't do any more damage.

Ideas on where to get the stomach lining from: could they remove a thin layer (not the whole thing) from the patient's stomach? Could they transplant it from a dead person? Could they grow it in a test tube from stem cells? Could they grow it in the esophagus itself from stem cells?

I'm not exactly sure how this could be done, but they can do face transplants and sex changes! Surely they can install a few inches of new lining!

Things They Should Invent: free chalk in public spaces at all times

Inspired by the impromptu memorial to Jack Layton, I think chalk should be available in all concrete-intensive public spaces at all times, so people could write or draw whatever they want on the concrete. Write whatever's on your mind, comment on other people's graffiti like people do in the more interesting bathroom stalls of the world, draw hopscotch and other playground games on the ground and watch as besuited office workers use them on their lunch break.

The first thought that springs to the minds of people who are going to object is "But people might write bad things!" That's okay, the beauty of chalk is that it's easily erasable (and washes away with each rain anyway). And in between rainfalls, public space can become a constantly evolving dialogue and art installation. Isn't that the essence of what public space is for?

Cutest thing ever of the day

Warning: this will make you ovulate

On being hungry

The first symptom of what turned out to be GERD was a feeling of food being stuck on the back of my throat, which, over the next few days, quickly progressed to difficulty swallowing solid food. Food would simply take too long to pass through my esophagus, until I got to a point where I could only eat about a quarter cup of food and then had to wait a couple of hours for it to move down far enough to make room for more food. What with not being certain if it's a problem and then wanting to wait and see if it would go away by itself and then having a long weekend delay my initial doctor's appointment, I ended up spending over a week physically incapable of intaking anywhere near enough food.

And here's what I learned: being hungry makes me slow, stupid, and clumsy.

It took me about four or five days of not being able to get enough solid food down my throat to come up with the glaringly obvious idea of getting some liquid meal replacements. I read more slowly than usual, made more typos than usual, and often lost my place when proofreading. I spilled things on myself about three times as frequently, so that at any given time I'd have a wet spot or a stain on my shirt. I walked more slowly than usual. I got more easily distracted and frustrated by co-workers in other cubicles having ordinary conversations. I'd sometimes forget myself and scratch or pick my nose while in my cube or walking down the street where other people could see me.

Basically, I turned into one of the dumb kids in school. Not just the ones who got bad marks, but the ones who were slow and loud and messy and didn't follow instructions well and didn't listen to the teacher and did things like fall out of their chairs. The ones that my classmates, in the ignorance and cruelty of childhood and the language of the 80s, would have called "retards".

I've always been an A student, but if you took my hungry self and stuck her in school, she wouldn't have been able to achieve any better than a B if she's lucky. So what happens when you take an average student, someone less academically inclined, and send her to school hungry?

I've been doing my job with the benefit of sufficient caloric intake for 8 years, so I had a reputation for being competent at my job and not a total idiot in life in general, so a week of being slower than usual didn't do much harm. Plus I was having a clearly articulable, if then-undiagnosed, medical problem, so if anyone noticed I wasn't myself I could explain why. But what happens if people only ever see you when you're slower? What if this situation is baseline for you, so it never occurs to you that you could solve it with the input of more food?

Every once in a while, the idea is raised of schools providing breakfast so disadvantaged students don't have to go to class hungry. And one of the objections I always hear is parents talking about how their own kids sometimes just don't eat breakfast even though it's available at home, and complaining that all the food will end up going to non-disadvantaged kids who are just too lazy or spoiled to get up 15 minutes earlier and eat some oatmeal.

But based on this experience with undernourishment, and based on how it correlates with the traits of the kids who got labelled as stupid - and probably ended up thinking of themselves as stupid, because the whole time they were in school they were slower and clumsier and more easily distractable than everyone around them - I am absolutely certain that it's worth it to feed everyone who is interested so that those who are undernourised can be properly nourished. When I couldn't eat enough, my performance in all areas of life dropped a full letter grade. Imagine raising the most disadvantaged students' performance by a full letter grade with nothing more than a daily meal!

I don't have terribly high self-confidence, but I do have a certain sense of what I can do by virtue of the fact that I've always been an A student. Of course I can get into university! Of course I can do the next set of word problems in my math book! Of course I can read that great big long novel! But if this undernourishment had happened over a longer period of time when I was just starting school, my perception of my own capabilities would be a full letter grade lower as well. Instead of "Of course I can get into university!" it would be "Maybe I can get into university if I'm lucky." Which doesn't sound like a big deal, but imagine how it would play out at lower grade levels. "I'll never be able to read that book" could, with the simple application of food, turn into "I've never read a chapter book before, but it looks interesting so maybe I'll try." "I'll never get into university so there's no point in applying" could turn into "Maybe I'll apply and see if I get in anywhere." "I'll never be able to afford university" could turn into "Maybe I'll apply and see if I can get a scholarship."

I'd say those kinds of outcomes are certainly worth giving food to children even if they don't strictly need it.

Musical interlude

A couple of weeks ago, I ended up crying on the phone to my mother about all the things upsetting me about my GERD diagnosis. I don't often do this (I can't remember ever doing it in my adult life), but it made me feel a bit better. I was rather pleased to discover that crying to mommy still works and glad that that's an available option.

The next day, as I was getting ready for work, I heard that Jack Layton had just died. On top of everything else, he's exactly the same age as my mother, and his son is the same age as me.

This is the song that got me out the door that morning.



PS: Check out around 2:21 - let's just throw a guitar across the stage for no particular reason!

Overstock.com has good international shipping

I recently ordered something from Overstock.com. I was a bit hesitant because they ship by DHL (with which I've had bad experiences in the past), but I ultimately decided to buy it anyway because of the price and because the possibility of delivery is more convenient than having to go out to a store and schlep it home.

The first pleasant surprise is that Overstock guarantees the shipping and duty price - no COD! - which means that I can ask my super to accept the package for me.

The second pleasant surprise was when I got a Canada Post delivery notice, went to the post office, and found out that it was my Overstock order.

It turns out they use a service called DHL Globalmail for their international shipping (to Canada at least). I don't know exactly how it works, but on my end the result is that I get all the benefits of Canada Post delivery - no COD and the package ends up at the post office a block from my home rather than at some remote depot.

I'm very happy about this, and because of the convenience of the delivery I won't hesitate to order from Overstock.com again in the future.

How to get people to stop asking you for money

Put in your earbuds and walk down the street at your normal brisk, businesslike pace. Whenever you see someone panhandling or fundraising or otherwise trying to part you and your money, make direct eye contact, smile, nod, say "Good morning", and keep going without once breaking stride. Do this for a couple of weeks, and they'll all start ignoring you.

The earbuds give you plausible deniability of having heard the exact words they use to greet you, allowing you to make your own script. The direct eye contact and acknowledgement eliminates any incentive for them to take extraordinary measures to attract your attention. And the full polite greeting gives you control over the entire script for long enough to pass the other person walking at your normal brisk, businesslike pace.

After a couple of weeks of this, the panhandlers catch on that you're useless and focus their efforts on other people.

Slice of life

The time: just days after my 16th birthday. The place: driving school.

The driving school has three teachers. Two are fat and one is thin. (Which is a horrible way to characterize human beings, but it is the characteristic that is relevant to this story.)

On the last day of our in-class instruction, we're told to go up to one of the teachers and sign up for in-car lessons. A large number of students flock to the thin teacher. My first thought is that they're discriminating against the fat teachers, so I should counter that by choosing one of the fat teachers.

One of the fat teachers taught our in-class sessions, so I decide to choose the other one so she'll get a chance too. And that's how I decided who my driving teacher would be.

Looking back with 20/20 hindsight, it is now apparent to me, based on my and my peers' experiences with the different teachers available, that the thin teacher was a better driving teacher. Everyone I know who had her said she was good, and they all turned out to be good drivers. Word had obviously spread about who the best teacher was, and I never thought to ask around because it never occurred to me that we'd get to choose our own teacher, or that it would even matter who our teacher was.

My teacher wasn't as good, in that she wasn't able to tell where I was at or what I didn't know. She assumed things were obvious to me that weren't, and gave me B's and C's on my in-car skills without telling me how to do them better. (And, me being my 16-year-old self, it never occurred to me that I might be allowed to ask.)

I'm certainly not under the impression that it's my teacher's fault that I'm a bad driver. I'm inherently nervous and skittish and clumsy. I'm not that good at manoeuvring my own body in space, never mind a giant metal machine. I find the act of driving exhausting, having to be so alert to so many things all the time. But sometimes I wonder if things might have turned out if I'd made a better decision in choosing my teacher.

Is medical science working to eliminate the need for virtue?

The lifestyle changes that I've been whining about are considered, both by conventional and alternative medicine, to be the first step in treating the condition. The standard way of thinking is maybe they'll be all you need, and that would be a good thing. Medication and procedures are intended for more extreme cases, where lifestyle changes don't work.

This has me wondering: is anyone in medical science even thinking about it the other way around, i.e. can we invent a medication or procedure that would make the lifestyle changes unnecessary? Just make you not reflux at all, so you can have as much acidic food as you want?

(I haven't done extensive research this far, but what information I have suggests that medication for GERD are unsustainable in the long term because they can deteriorate your bones, and available surgeries might not necessarily last the rest of your life and might need to be redone. If you know of a medication or surgery that actually does stop GERD without lifestyle changes, please post it in the comments, I beg of you!)

This also reminds me of smoking. If you smoke, you're supposed to quit. There are tools to help you quit. But is there, or is medical science working on, a way to counter the harm done by cigarettes? Smoke a cigarette and then taken an anti-cigarette pill or something?

I've never heard of anything like this for anything.* Is that because science hasn't yet figured out how?

Or is that because of the Protestant-work-ethicish societal attitude that we should all just Be Good and Virtuous if we want our lives to work well?

I find myself wondering if that's true. So many of the people I've whined to were all "Oh, it's no big deal, you just have to make a few changes." But that's what's making me unhappy!

You'd think capitalism and big pharma would get behind this. Now, instead of people buying cigarettes, they can buy cigarettes AND anti-cigarette pills. Come on, get on it, our economy needs a boost!

*Update: I can think of one example: the morning-after pill. Another possible example is insulin, but I don't think diabetes management is quite up to the point where you eat whatever you want and then take the corresponding amount of insulin. Unless, of course, it is, in which case more power to you!

Teach me about driving

In driving, apparently you're not supposed to pass on the right. So if you're in the right-hand lane and the lane to your left is moving slower, what are you supposed to do?

(I honestly don't know. As I've mentioned before, I'm a bad driver, so I never got comfortable enough driving faster than other cars for this to ever be an issue.)

How to raise taxes so it doesn't hurt

There are a number of jurisdictions in the world where raising taxes would be useful, but people don't want them to because it will hurt. Here's an idea on how to possibly make it not hurt.

If tax brackets are constructed properly, people whose gross incomes increase will always have a higher net income, even if it puts them in a higher tax bracket.

However, if taxes increase, it's possible that people whose gross incomes increase or stay the same might end up with a lower net income than before, and that's where it really hurts. (If your gross income and net income both increase, you still feel like "YAY, more money!" If your gross income decreases your net income will also decrease and that will hurt, of course, but it will hurt regardless of taxes.)

Here's an example of how it works. For simplicity, I'm pretending there's only one tax bracket. The principle still applies with tax brackets, it's just that even fewer people would be affected.

Suppose your gross salary is $50,000 and your tax rate is 20%. $50,000*0.8=$40,000, so your net pay is $40,000.

Suppose they raise the tax rate to 21%, and at the same time you get a raise and your gross pay increases to $51,000. $51,000*0.79=$40,290. So your net pay is still higher than it was last year, even though your tax rate has increased.

Now suppose that, instead of $51,000, your gross pay increases to $50,500. Your net pay would be $50,000*0.79=$39,500, which means you'd be taking home less money than last year even though you got a raise. THAT would suck.

So what they need to do is have some kind of grace period for the people in these margins, whose gross income increases but net income decreases because of the tax hikes. Maybe for a year or five years or something reasonable, they could guarantee that if your gross income increases, your net income will not decrease. If your gross income decreases, your net income will remain the same proportion of your gross income.

Given the nature of inflation, unless the whole economy is tanking (which it might actually be...), this will affect very few people. In the example I gave above, the pay raise to $51,000 is a 2% increase, and 2% is generally the target inflation rate. So everyone who isn't falling behind will still get a net pay increase. All they need to do is put in a bit of a net income guarantee for those who are falling behind, and it won't hurt.

Economics questions inspired by The Onion

A headline from The Onion: "Cackling Warren Buffett Burns Entire Fortune In Front Of Nation"

Seriously though, if that actually did happen, how would that affect the economy? Not Warren Buffett specifically, but what would happen if billions of dollars in cash were eliminated from circulation?

Somewhere along the way in life, I absorbed the idea that government can't just print more money to pay their bills because that would drive up inflation. If this is the case, burning a large quantity of cash should, logically, result in deflation. This would drive prices down, which would be useful to people whose incomes wouldn't immediately be driven down accordingly. If you owe a big mortgage and your income drops with deflation you might be in trouble (unless the money you can save on your more variable expenses makes up for it), but if you have a fixed salary and your expenses are either fixed or dependent on market forces, it would get a bit easier to make ends meet.

I don't know how many people fall into each category, but is it possible that if Warren Buffet burned his entire fortune, the economic consequences would make life easier for millions of people?

Another question is whether, if inflation would in fact be cause by printing large amounts of currency and, conversely, deflation would in fact be caused by the disappearance of large amounts of currency, does this phenomenon only work if the markets know about it? If they printed more money in secret, or if Warren Buffet locked himself in his office and ran his entire fortune through the paper shredder, would they still have the same economic impact?

More information please

The dignitaries smiled for the cameras, gamely wearing blue hardhats with grey shark fins protruding from the top and sides.

All, that is, except Ontario Tourism and Culture Minster Michael Chan, whose hardhat was distinctly de-finned despite the fish-themed frivolity at the ceremonial groundbreaking for the new Ripley’s aquarium.

An organizer of the event told the Star that Chan’s office said the minister would not wear the fake fins because of growing controversy in the GTA over the harvesting, selling and serving of sharkfin soup.

So does that mean he's for or against sharkfin soup? Seriously, I can't tell.

One more complaining post, then I'll blog about something different next

People I know who have serious or chronic medical problems complain that they feel betrayed by their body. Their body has always been strong or beautiful or fertile, and then suddenly it's not and it betrays their vision and sense of themselves.

I've never felt strong or beautiful or fertile. I've never needed to play sports or wear small clothing sizes or bear children or perform fantastic feats of sexual prowess or walk long distances or lift heavy things or be energetic or any of that stuff. I've always been quite willing to cheerfully admit that my body is pretty much useless for anything except sloth, and I have no problem with that.

Similarly, I've never been a terribly indulgent person. I'm an introvert with low novelty-seeking. I don't need to travel the world or climb mountains or set world records. I'm happy alone with a good meal and a good book. My happy places are food and fandom, and food is the only one over which I have control. (Fandom is dependent on other people creating new stuff - whether it be canon or forum posts - whereas I can just go buy a slice of cake whenever I want.)

This bastard knew just where to get me where it would hurt the worst.

Why I find my reflux disagnosis disempowering

The problem with reflux management protocol is that most of the lifestyle changes are negative. Don't eat this, don't eat that. Don't eat at these times or under these circumstances.

This is why I feel disempowered.

I felt empowered after my initial appointment with my doctor to treat my swallowing problem. He examined me, ordered some tests, and prescribed the most likely useful medication (which he totally got right in one!) I then had things to do. Go to the lab, drop off this culture, and give them some blood. Go to the pharmacy, fill this prescription, take it as directed. The results will either be useful or informative. Report to this location at this time to drink barium. I was helping generate data and find solutions.

One thing I found very useful in managing my weight was eating a salad when I got home every day. It wasn't a don't. I was totally allowed to eat whatever I wanted. I just had to have a salad first. And, over time, I could see a tangible achievement: look how my weight is dropping!

That's also how I manage my money. I divert a certain amount from each paycheque into a different, less accessible account. I'm not telling myself I can't buy stuff. I can buy whatever I want! I just have to move that money aside first. And, over time, I could see a tangible achievement: look at my life's savings!

But what are my achievements in managing reflux? I didn't eat tomato sauce today or yesterday. My morning coffee was 25% smaller. I didn't have wine yesterday. Those aren't tangible, and if I think about them too much I'll feel deprived. And the best possible result is I'm not feeling this little feeling that isn't even painful and is barely even present but makes me paranoid (although it was less present and paranoid-making today than yesterday.)

So I somehow have to figure out how to turn all the thou shalt nots of reflux management into positive actions to take.

I have a small, initial positive step. Traditionally, while I do my evening wind-down, I drink a glass of wine, a glass of milk, and a cup of sleepy tea, all over a period of two or three hours. The prospect of prohibiting wine is too overwhelming at this point, so what I'm doing is changing the order. Now it's milk, then tea, then wine. This means I might be ready to fall asleep before it's time for the wine, so I'll be ready to go right to bed without actually using self-discipline to deprive myself of the wine. It worked yesterday, while watching a comfort-food movie and doing my bedtime ablutions during commercial breaks. Will it work consistently? I have no idea.

Ironically, my high rate of tomato sauce consumption was originally a small positive step in eating healthy. I found myself craving pasta with tomato sauce with some frequency, so I decided to routinely eat it every day in as healthy a combination as possible (multigrain pasta, low-fat cheese, sodium-free tomato sauce) and eat it for breakfast. That nipped my craving in the bud and got a large, healthy breakfast into me so I could be alert for work and eat less later in the day when it's less healthy to do so. And now it looks like it's been hurting me all this time.

My 2008 New Year's Resolution was to step back when I'm feeling frightened and overwhelmed and use the tools at my disposal to restore my mood rather than trying to push my way through dark moods (which, I'd discovered, just prolongs them). This has served me very well and made my life much easier. But, I've discovered, one of the most effective tools to make this happen is comfort food, all of which is now contraindicated.

Diagnosis

So my barium swallow found that I have gastroesophageal reflux disease, commonly known as acid reflux. I should be happy about this - no narrowing of the esophagus, no damage, no mysterious lumps, the little valve between my esophagus and my stomach is just refluxing some. But I'm finding it disproportionately and irrationally upsetting.

The first reason why I'm upset is that I wasn't feeling any heartburn, I was just having trouble swallowing (apparently the reflux was causing my esophageal muscles to spasm, which explains why applying icy hot to the outside of my neck helped food go down smoother), so now every time I feel any little thing in my upper torso I'm all "OMG, is that heartburn?"

The second reason why I'm upset is it's chronic. I've had it for an unknown period of time (possibly even my whole life, we have no way of knowing) and it won't ever go away. I've never had that happen before. Every physical ailment I've ever had has always gotten better. It's a stupid thing to be whining about, I know, and many many people have chronic conditions, but it's a bit of a mindfuck and a paradigm shift.

The third reason why I'm upset is the list of things that contribute to it is rather extensive. From the literature my doctor gave me: "Alcohol, being overweight, smoking, citrus juices and tomato products, chocolate, tea, coffee, carbonated drinks, fatty and fried food, highly acidic food (pickles, sauces and vinegar), peppermint, onions, garlic, spicy foods." I don't smoke and I'm slowly and steadily working on the being overweight part, but I love everything on that list! When I'm stupidly stressed or upset like I am now, (and, ironically, one of the recommended lifestyle changes is to reduce stress) I reach for a glass of wine and some comfort food. They're now contraindicated. And when I eat something on that list (which even includes my fricking salad dressing because it has garlic and vinegar in it!) I get in this loop of worrying about every little thing I feel in my upper torso, then worrying because I'm getting stressed.

Intellectually, I know that I don't have to cut the contributing foods to zero. I know from experience in many areas of life that small changes can make a difference. I've been mindlessly eating tomato sauce pasta dishes every day of my life for the past 15 years. I can easily get that down to twice a week, and might even be able to get it down to once every couple of weeks. That in itself should make a noticeable difference. I can cut out mindless afternoon coffees that I don't really need. I can cut out spicy foods that I have no particular enthusiasm for but end up eating from time to time because I feel like my taste in food should be more worldly. But emotionally I still feel bad and guilty and like I'm doin it wrong for not being able to do it perfectly, and emotionally I'm still mourning the loss of so many of my favourite foods even though I don't have to lose them entirely, and then I feel bad for stressing because I'm not supposed to.

Intellectually, I know that I'm not even feeling pain (just freaking out over every tingle and itch in my upper torso) and that the purpose of the recommended lifestyle changes is to reduce discomfort, but emotionally that isn't making it any less overwhelming.

Intellectually, I know that this is a good diagnosis for the symptoms. My esophagus is not damaged. I don't require any procedures where they stick a scope down my throat. But I wasn't emotionally prepared for something that won't go away ever, even though it's minor.

Intellectually, I know that the medication I'm taking (Dexilant) has gotten excellent results so far and is going to fix my esophagus even more during the one-month course I'm taking. Two weeks ago I was physically incapable of eating more than four strawberries. A week ago I was eating normal amounts but having various side effects. Now I'm eating normal amounts and not having the side effects that I was having a week ago. If these silly little feelings that are making me nervous are in fact in my esophagus, this medication will make them better before I finish. I know that if, once the medication stops, I start having further difficulties, I can easily get more of it. But I can't seem to make myself be patient.

Intellectually, I know that life is basically the same. I've already had reflux for some time without knowing it, and I'm actually more empowered know because I know what it is and how to prevent it and what meds to take if it gets unbearable. But I suddenly feel disempowered, like it's completely outside my control.

And, intellectually, I know that at least half the people reading this are dealing with some worse medical condition. But I still can't turn off the useless part of my brain that's stressing needlessly and making me whine to y'all.

My barium swallow experience

My doctor ordered a barium swallow as one of the tests to diagnose my difficulty swallowing solid food. Obviously the first thing I did was google it, and read many scary things. Turns out it wasn't nearly as difficult or uncomfortable as the internet suggested. Here's my experience:

The referral went through in one week, and my test was scheduled two days after that. It was scheduled for 8:15 a.m., and I was instructed not to eat or drink anything after midnight the night before.

Once at the clinic, I checked in and had a negligible wait in the waiting room, and was then taken to a dressing area (co-ed, but individual stalls with curtains for doors) and was instructed to remove all clothing and jewellery between my shoulders and waist and put on a gown. The gown as big enough to wrap all the way around me once I could figure out how to tie it properly, although an older gentleman who was in at the same time seemed to have trouble getting his to tie properly and his was gapping. I was then taken to another area (had to walk in gown and pants through an area populated by medical professionals and gowned patients of both genders) where I was shown to an examination room. The only people in the examination room were me and the doctor, and the room had a door that closed.

The doctor had me stand on a platform, took some images before I drank the barium and some pictures after I drank the barium. He then had me drink something fizzy and took more images. Then he told me to hold onto the edges of the wall behind me, and, to my surprised, it started tilting backwards until I was lying on a table. He then had me move into different positions, tilted the table to different angles, and had me drink barium with a straw followed by drinking water with a straw, taking images all the time. This process lasted about 15 minutes, after which I was directed back to the dressing area, changed into my own clothes, and was free to go. I left the clinic 23 minutes after my scheduled appointment time.

The internet told me that the barium would taste chalky and kind of gross, but to me it tasted like nothing. The adjective "chalky" suggested to me that it would make me even more thirsty than I already was (remember, I hadn't had anything to drink in 8 hours), but instead it made no difference to my thirst - neither quenched it nor worsened it. Basically, it didn't make any difference to me whatsoever whether there was barium in my mouth or not.

I found the test easy, noninvasive, and completely free of discomfort. I wasn't entirely thrilled with the co-ed dressing area and walking around in a gown (I'm accustomed to changing in the examination room) but nothing went amiss in the dressing area and, since I could keep my pants on, I was actually more covered in the gown than in my street clothes. If changing clothes in one co-ed area and then walking to another area is in fact logistically necessary, they could resolve my privacy concerns by installing doors with locks on the stalls (like most clothing stores have) rather than using curtains like they do right now.

But, overall, it was no big deal and if I ever have to have one again I will have no dread whatsoever.

Takeaway:

- Time between GP appointment and being informed of barium swallow appointment: 1 week (7 calendar days, 5 business days)
- Time between being informed of barium swallow appointment and date of appointment: 2 days
- Time between test and when I was called with results: probably 1 day. (My doctor's office called me the day after the test, but I wasn't able to get back to them before closing so I don't know what it was about yet)
- Preparation: nothing to eat or drink after midnight (for an 8:00 appointment)
- Time in waiting room: negligible
- Total appointment time: 20 minutes
- What it tastes like: nothing. It neither quenched or worsened my thirst
- What to wear: separate tops and bottoms, because you're allowed to keep your clothes from the waist down
- What to bring: apart from whatever paperwork you need, bring a full bottle of water because you're going to want to drink water when it's over.
- Recovery: negligible. You'll probably need some food and water because you'll have been fasting, but you can walk right out of the lab and straight back into real life.

Teach me how layoffs work

Take the city’s buyout package now or you might be laid off later, Mayor Rob Ford warned 17,000 city workers who have so far spurned the effort to get them off the payroll.

Ford, appearing Friday morning on Sun News Network, was asked about layoffs in light of a Star story revealing that his administration now feels they are inevitable because of very low take-up of the city’s buyout offer.

“Now if they don’t take the package, what else do we have to do?” Ford said. “We might have to lay them off.”

If more of the eligible workers don’t agree to leave their jobs in exchange for up to six months’ salary, the city has no choice but to issue layoff notices to cut labour costs and tame the 2012 deficit, he said.

“The last thing we want to do is put somebody out on the street so we’re working and saying here, here’s a package, I’d advise you to take it. What else are we going to do?

“If someone else can come up with a solution, let me know.”

The internet's general interpretation of this statement is that people who volunteer will get packages, but if not enough people volunteer and the city has to forcibly lay off some people, those who are forcibly laid off won't get packages. I haven't been able to google up anything that explicitly confirms or disproves this interpretation. (If you have something more definitive, please do let me know in the comments.)

Is it normal to offer packages to those who volunteer to be laid off but not to those who are forced to be laid off? If so, why? The employer can afford to give packages to X people anyway, so why be so assholic about it? What does the employer gain by having people "volunteer" under duress rather than choosing who goes?

In the specific case of the City of Toronto, if they do in fact intend to offer packages only to people who volunteer, why are they encouraging more people to volunteer? If fewer people take packages, they'll have to spend less money. And if the general interpretation is incorrect and people who don't volunteer but are laid off anyway will in fact get packages, we're back to the question of why are they encouraging people to volunteer when they don't really want to?

An explanatory note

I recently experienced some kind of medical problem that made it difficult for me to eat enough. My doctor promptly prescribed a medication that has made it possible for me to eat normally again, and I'm in the midst of a battery of tests that's intended to diagnose the specific root of this problem and determine what treatment is needed, if any.

I'm writing this because I intend to blog about my experience with some of the medical tests (to make the kind of info I was looking for going in googleable), and I might blog about some thoughts arising from some of the symptoms. And I know it all sounds kind of scary when I'm sitting here saying that I couldn't eat properly, suddenly obsessing about medical tests, and not yet having a name for my ailment.

So here's the takeaway: nothing to worry about. I am now able to eat properly, I'm receiving appropriate medical care in a timely manner, and it's quite possible the medication I'm already taking is the actual solution to the problem. If not, it's going to be either an additional medication or a routine outpatient procedure.

This is getting blogged about because it's all very new to me (this is actually the first time in my adult life I've gone to a doctor without already knowing my diagnosis and necessary treatment), but as medical treatment goes it's objectively unremarkable and all this blogging is just my usual self-absorption.