How I want my doctor to approach alternative medicine.

I was pleased to see that CPSO is considering guidelines that are more open-minded about alternative medicine, but I'm concerned at the kinds of criticism this idea is receiving.

I would love to have my doctor give me alternative medicine advice because then I'd get one-stop shopping. My doctor would tell me if I would benefit from seeing a gastroenterologist or a gynecologist or a dermatologist. He would tell me if I would benefit from taking a certain vitamin or if I should avoid a certain over-the-counter drug. I'd also like him to tell me if I'd benefit from seeing a naturopath or taking a certain herb. I don't want to have to come up with the idea myself.

However, it concerns me that some organizations don't want CPSO even thinking about alternative medicine because it's "unscientific" or "unproven".

The reason why many alternative therapies are "unproven" is because they aren't required to undergo the same scientific testing as conventional medicine, so they often don't. The fact that they're unproven doesn't mean that they don't work, it doesn't mean that they're dangerous, it just means that the science hasn't been done yet.

Analogy: I have never in my life undergone any sort of formal English-language proficiency testing. That doesn't mean I can't speak English. Of course, you can't go around blindly assuming that I can speak English either, but you could conduct an informal, unscientific test by speaking to me in English, and the results of that would be a pretty good indicator.

I'm also worried that critics seem to be assuming that unproven = harmful. It's very possible for something to not have been tested scientifically but not be harmful. It's even possible for it be ineffective but not be harmful.

Analogy: When I was having difficulty swallowing, I googled up the reflexology points for the esophagus and massaged them. Is reflexology scientifically proven? A quick google is inconclusive. (To say nothing of the fact that my amateur attempt at reflexology was probably not properly done.) But it certainly wasn't harmful for me to sit there massaging my own feet on the off-chance that it might help.

One of the (many) things that frustrates me about GERD "treatment" is that conventional medicine and naturopathy recommend different (and often contradictory) diet changes. For example, conventional medicine says no to citrus and yes to low-fat milk products, and naturopathy is the other way around. So I find myself in the position of having two trained, credentialed, experienced professionals, both of whom have gotten results for me in the past, telling me opposite things. And, because I don't feel pain when I'm refluxing, I can't even do an experiment and see which works best for me.

I see conventional and alternative medicines as complementary tools in my toolkit, and I want my practitioners to work together as a team rather than competing with each other. When I see medical professionals getting alarmist, conflating "unproven" with "dangerous", it starts making me wonder if they have something to hide. And I don't want to be wondering if they have something to hide, because I need to be able to trust them - I'm not smart enough to figure stuff out myself.

If my doctor were to start warning me away from all alternative treatments just because they haven't gone through full clinical testing, I'll just end up feeling disinclined to tell him about any alternative treatments I might be experimenting with. I want him to warn me away from anything known to be dangerous, point me towards any treatments or alternative medicine professionals likely to be useful, and non-judgementally give me any information he might have about things that are harmless but likely ineffective. Anything less is useless to me and weakens the credibility of his profession in my eyes.

Why I've lost confidence in Dell

Every computer I've ever owned myself has been a Dell. Up until this past week, my experience with them has been consistent: I get 4ish good years of use, then have a hardware problem. The faulty hardware problem is promptly resolved via excellent warranty support, and I get another year or two out of the computer, after which I'm happy to replace it for something more up to date. Because of this longevity and excellent support, I've always blindly turned to Dell when buying my next computer, figuring it means I won't have to worry about my computer for five years.

Unfortunately, this confidence was shattered this past week.

The computer is a Dell XPS 15 bought brand new in December 2010. Last Saturday, I started having problems with Windows loading. Sometimes it would freeze on the Welcome screen, sometimes I'd get a black screen with a mouse cursor, sometimes the desktop would load but nothing I clicked on would do anything. After a System Restore failed without rebooting Windows, I called tech support.

I didn't have to wait on hold at all, just do the menu dance, and a very nice tech walked me through some troubleshooting. I appreciate his work because he started at a more advanced level than I'd been troubleshooting at rather than reiterating the basics, and was very patient through a troubleshooting process that took over an hour. We eventually determined there was a problem with my wifi adapter (I hadn't noticed because my primary internet connection uses an ethernet cable), so he uninstalled and reinstalled it, and my computer booted up beautifully. He then told me that I'd be receiving an automatic follow-up email, and if I had any further problems I should forward the email to the address indicated and they'd give me a priority call back. Brilliant idea! That would mean we don't have to troubleshoot from scratch if the problem reoccurs!

Unfortunately, the problem reoccured the next day (Sunday). And, on top of that, the computer couldn't find the wifi adapter that had just been reinstalled the day before. So I forwarded the email to the address indicated and got an automatic reply saying they aim to reply within six hours during their business hours (9-7 Central).

But they never called back.

I emailed again on Monday and Wednesday and tweeted @DellCares (who requested a DM with pertinent information and said they'd look into it), but I never got my callback.

Meanwhile, my computer was deteriorating. I was working in Safe Mode with networking, unable to access games or music or word processing. Boot-up was slower each time, the computer couldn't always detect its network card, bizarre things started happening (itunes opening when I plug in my ipod even though I specifically set it not to do that, then telling me it couldn't read the iphone even though it isn't an iphone; browsers giving me random encoding errors even on simple websites).

On Thursday, I gave up. I got an external hard drive, backed up all my stuff, and reinstalled everything from scratch using my recovery disk. It took three hours (back-up, reinstallation, and getting all my settings just so), but everything has been working properly since then (knock wood).

But this makes me lose confidence in Dell for two reasons:

1. Serious, mysterious problems that hinder useability even though my computer is only nine months old. I've never before in my lifelong relationship with Dell had to actually use the recovery disks. This makes me nervous. Whenever a boot-up takes a second or two longer than usual, I start worrying that it's a sign of a serious problem.

2. I didn't get a "priority" callback! I waited five days, requested it four times through two different mediums, and no one called me. I've always gone with Dell because I could trust their support, and now I can't? And this despite the fact that I invested in the biggest warranty possible? What will happen when I have a bigger hardware problem that can't be fixed with a full reinstall?

In the interest of fairness, I should say that I never called Dell back either. I had the option of calling them again and starting from scratch, and I opted not to, first because I still had internet access in safe mode and I decided I'd rather relax and go about my life than wait on hold/going through first-level support. I figured the phone would ring when there was someone ready and available to give me second-level support. I should also point out that, in response to my second complaint to them, @DellCares apologized and told me to contact them so they could escalate me if the problems reoccur after reinstallation.

But I've still lost confidence, mostly because they specifically told me that forwarding the email to the address specified would get me a priority callback, and it didn't. What other promised support might I not get in the future? What if it happens when I need to work? What it happens when I'm away from home and my full resources and dependent on wifi? (That is why I bought a laptop in the first place, even if I don't often end up taking it out of my apartment.) What if I were a less technically proficient customer and a full recovery wasn't easily feasible for me? And WTF even was the problem in the first place?

This loss of confidence spirals out and affects my interpretation of my whole relationship with the company. For example, during my tech support call, the technician told me about a product Dell solves that detects and repairs problems with your system. It was clearly part of his script to push this product, which I normally wouldn't have given any thought. But sitting there working in Safe Mode awaiting a callback that wasn't coming, I started wondering if they put something in the computers to deliberately make them malfunction so they can push this product.

Sometimes when people blog about problems with products or support, the company wants to make it right. The unfortunate thing in this case is that there's nothing Dell can do to make it right, apart from doing their jobs properly in the future. Getting my callback now would be useless since I got the computer working. Free stuff would be useless because there simply isn't anything I need from Dell. A store credit would be irrelevant because there wasn't money involved in this interaction, unless they wanted to give me a store credit that would last for five years and win back my trust in the meantime. (If I do have to buy a new computer in less than five years, it won't be from Dell).

All Dell can do to win back my confidence is have my computer work properly for the rest of its planned life, and give me support properly next time I need to call them, preferably without trying to sell me software at the same time. But, even so, I'll probably be doing at least some cursory comparison shopping next time.

Update: Dell initiated a follow-up call on Tuesday (9 days after I requested a call back) and we made contact on Wednesday after a round of telephone tag. They apologized for the delay, saying it was due to "technical reasons" (which doesn't instill confidence when I'm after a solution to a technical problem), listened to my whole story, and apologized for the mix-up, but there wasn't much else they could do for me because I'd already used the recovery disk.

Programming note

Currently experiencing technical difficulties. Blogging will resume once they've been resolved. Expect a review of the Dell XPS 15 and Dell warranty support once I'm back.

What to do when someone is standing in front of the seat you want on the subway

I always get really annoyed by people who stand in front of empty seats on the subway, blocking access to those seats for others who might want to sit down.

The other day, I was inadvertently that idiot standing in front of the seat. (The seat was vacated just before I was about to get off the train myself, and I was too oblivious to think to move.)

This lady moves in towards the seat, but I'm blocking the way. So she says to me "Oh, sorry, were you going to sit there?" Which led me to step back from the seat, give it to her, and apologize.

Some people argue that you should just ask standers who are blocking seats to move so you can sit down, but not everyone is comfortable with that approach and it is marginally confrontational, asking the stander to stop doing something (thus implying that they're being bad). This lady's approach allows both people to save face and look generous by offering the seat to each other, with the same end result.

Thanks, subway lady, and I apologize again for blocking your seat!

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.