Tuesday, August 19, 2014

foodmap

I haven't felt well for a long time. So long now that I don't remember what living without pain feels like. After months of increasingly frequent episodes of acute pain, along with a lot of free time on my hands, I finally decided to do something. What I mean is, against my natural instincts, I went to the doctor.

And that's how I ended up with an unclear diagnosis: probable fructose malabsorption, lactose intolerance, gluten intolerance (Celiac), and irritable bowel syndrome. The all encompassing term to describe my digestive system ailments is that I have a "functional gastrointestinal disorder" or FGID for short.

What I mean by unclear diagnosis is that, despite pretty definitive testing methodology, my food intolerances are each on their own continuum. I am somewhere on the spectrum for what I can tolerate (for example, I'm very low on the Celiac spectrum). According to my team of GI doctors, the understanding, and subsequent diagnosis, of digestive disorders is relatively new in the gastrointestinal world and these doctors (specialists) are still learning what it all means.

What it means to me is the difference between living life to its fullest, and not being able to leave my home or even sleep most nights. My intolerances have become debilitating, to say the least. And I still don't really understand them quite yet. At the beginning of this journey I had a feeling I'd be working with a GI for the long haul. And, true to form, I am. I'm working with three amazing GIs, have taken five tests (more to come), and, of course, spend every day reading about every possible condition on the internet. WebMD is a good, if not insanely dangerous, companion, since my medical training consists of being the daughter of a doctor (meaning not very solid).


My lactulose hydrogen breath test.
Used to diagnose small intestinal bacteria overgrowth (SIBO)

Unless you've been living under a rock, you know that there are a million stories going around the internet about how humans should avoid gluten, stay away from dairy, and eat like cavemen. Despite being an avid learner, reader, and internet browser, I am not a food fad subscriber. 
The thought that I may have to cut out entire portions of a certain type of food I love to eat is scary for me. I don't typically discriminate against food.

But I am now on a diet. Or at least I will be shortly. Once we know where the pain is coming from. First up, my small intestine. I'm finishing round one of a high dose antibiotic treatment. Xifaxan, the antibiotic of choice, targets my gut specifically. Whatever bad bacteria has infiltrated itself into my small intestine, its days are numbered. Xifaxan will kill the bad bacteria, keep the good. Pretty powerful stuff. 

Except that I can't get Xifaxan. After weeks of back and forth with doctors, pharmacies, and insurance companies (in at least two countries) Xifaxan is out of my price range (approx. $2K for the 42 pills I need to complete a two week regimen). Instead, I'm on a much harsher all encompassing antibiotic; Cipro. A travelers go-to miracle drug, its job is easy; kill all the bad bacteria in my gut.

But, it doesn't end there. I'm currently also using elimination diets to find out which specific foods I can and cannot tolerate. Almost everyone I meet has a suggestion for what I should eliminate from my diet. I hear a lot of, "you can't eat dairy, right?" and "if you tested positive for Celiac (which I did), then you can't have any gluten." But only I know what exactly I can and cannot eat. Because my gut is also not a food fad subscriber.


Once the bad bacteria is gone from my small intestine, it will be time to rebuild the good bacteria and manage the stomach pain (by watching what I eat). So, fad or no fad, I will be living a low FODMAP diet. 

FODMAP stands for "Fermentable, Oligo-, Di-, Mono-saccharides and Polyols." I realize that's a lot of vocabulary, but it really means that simply restricting FODMAPs from a diet has been found to have a beneficial effect for sufferers of irritable bowel syndrome, SIBO (small intestinal bacterial overgrowth), and FGID. That's me in a nutshell.

FODMAPS are a group of short-chain carbohydrates that are not very well absorbed in the gut (small intestine). These carbohydrates are easily fermented and cause fluid to enter the large bowel. Reducing the total amount of these fermentable sugars may improve IBS symptoms.


THIS IS WHAT I CANNOT EAT:

The low FODMAP diet list was provided to my by my doctor. It doesn't look like any fad diet I've ever seen. But that's because it isn't a fad. It's a lifestyle prescribed for me by a team of specialists.

What am I supposed to eat for the rest of my life? According to the low FODMAP plan, I can eat spinach, plain chicken, white bread, white rice, and potatoes. Ugh. Fortunately, over time I can introduce new foods into my diet to see if I can tolerate them or not. It's like learning to eat all over again.

I will admit that when I started to look into this diet plan I had no idea where to start. I needed a list of foods to eat. And a list of foods not to eat. And I needed it to be all encompassing. Should I eat any sugar at all? How will I know if what I'm eating is made from glucose, fructose, lactose, galactose, or sucrose? It has been overwhelming, to say the least. At least there's an app out specifically explaining the diet plan. 

I've also been thinking a lot. For example, if I choose not to go on a low FODMAP diet plan, will the bad bacteria come back? What about even if I do stick to the plan? And am I doing myself long-term harm by having eaten off the charts before?

To help answer some of my questions I have armed myself with books, websites, and of course my incredible team of doctors. My goal is simple: to live pain free. I think I'm on the road to learning how its done. But I'm a long way from having any clear diagnosis. 


In my immediate future are more tests; more watching and waiting and elimination diets. And possibly antibiotics. And when its finally time to get down to diagnosis, I'll have to undergo a small intestinal biopsy performed with an esophagogastroduodenoscopy (EGD). I'll spare you the details, but tissue samples will to be taken from the cell wall of my duodenum and varying parts of my small and large intestines and colon.

All I have to say is bring it on. I know it may sound a little backward to say I have to limit my fruit, vegetable, and wheat intake, but trust me that I do. I just want to get through the day without being in constant pain. And I also suspect that keeping my stomach healthy will contribute to my overall health and longevity. I'm in this for the long haul.

For more up to date research, including Xifaxan (Rifaximin) for treating SIBO and IBS, as well as more information about a low FODMAP diet, check out this article recently published in Health. http://news.health.com/2014/08/11/experts-issue-guidelines-for-treating-irritable-bowel-syndrome/

Monday, August 11, 2014

one-track mind


Outside of Mérida, Yucatán, along the road leading through Acanceh, past numerous tiny villages, lies the town of Cuzamá. Cuzamá is known today for its three cenotes (sinkholes) and attracts thousands of Mexican visitors every year, especially in the summertime. If you don't get confused and turn around on the way to Cuzamá, you will come upon a parking lot and a whole lot of tourists. From there, it only took us about half an hour for our horse-drawn carriage to arrive. Because about seven kilometers down a 150-year-old railroad track sit three pretty incredible cenotes. If you haven't had the pleasure of swimming in a cenote before, I highly recommend it. These freshwater sinkholes form when the limestone earth is fractured, allowing rainwater to seep into the fractures. The water running through these fractures dissolves more and more limestone until eventually caves form. Swimming in cenotes is one my favorite things in life.


Cuzamá wasn't always known for its cenotes. One hundred and fifty years ago, the Yucatán was at the center of henequen production. Haciendas, aka plantations, were erected all over the state and railroads were set up all throughout the peninsula. A horse drawn cart that runs on railroad tracks, called a truc, was the means of transportation used in the old haciendas during the 19th and 20th centuries.


Our truc arrived and I took my seat. I let the horse lead us along the track down the road to the cenotes. However, I quickly noticed, there was only one railroad track. One. I thought long and hard about this at first. One track, I thought. That must mean we all go in one direction at once and then all return at the same time.

Except that is not what happens. Every time we get a little momentum and rhythm going, another cart and horse appear heading straight toward us. So we quickly get off our cart, lift the truc and move it off the rails, wait for the other cart to pass, put our cart back on the track, and get back to it. This process continues like this every 5 minutes for 45 minutes.

video
I captured the art of moving the truc on and off the track to let the other carts pass

Why isn't there a second railroad track? I had to ask. My driver told me, "the railroad is 150 years old." Well, okay, that's amazing. But why not build a brand new track next to the old one and then in another 150 years you'll have one 300-year-old track and one 150-year-old track? The driver didn't seem to appreciate my additional questions.

But I couldn't just let my curiosity go. In 150 years did no one ever take the initiative to make life easier?

The answer is no. But I still wanted to find out why. Not surprisingly, the internet doesn't have any information about this. So I started to ask the locals. Why only the one track?

The answers soon started pouring in. One day the henequen just ran out. Voila, it was gone. And the haciendas? Abandoned. And the railroads? First, the iron was sold in pieces. Then the roads were paved over so cars and buses could drive on them. Modernism took over the 
Yucatán.

Henequen is a type of agave plant. The raw fibers from the henequen cactus are shredded, pulled, and wound together to make into rope for hammocks, twine for baling hay, and burlap bags.

Okay, this all makes sense, but if Cuzamá is still using the railroad track, why not invest the plentiful tourism profits into placing a second track? I thought this was a brilliant idea. But the locals had many logical explanations for me. First, the railroad track itself is over 150 years old. That means there is no more track of its kind. And furthermore, there are no local engineers. No one who would know how to place this type of track. I never thought of this before.

Also, there is some speculation that the people of Cuzamá are waiting for the Mexican government to give them the funds to improve the tourist route. There is no one in Cuzamá who will use his or her own profits or capital to add a railroad track when maybe some day the Mexican government will provide the support. Even if they have to wait another 150 years.

In the meantime, I'll head back to Cuzamá any chance I get. And its railroad track will retain its charm, as well as its place in history.

Tuesday, July 29, 2014

start me up

I can't remember the last time I've had to much fun. And learned so much. And made so many new friends so quickly. But that's what happens at Startup Weekend.

If you're like me, you don't run in tech circles. You don't have company CEOs as coffee dates, and you don't spend your free time on Arduino discussion boards. So how is it that I found myself trapped for three days in the basement of a Tech Museum (The Tech Museum of Innovation in San Jose) with these exact people?

I suppose it started when a friend sent me an email about Startup Weekend Bay Area Makers and I immediately signed up. I didn't think much about what I was signing up for. I only knew the event was local, during the weekend, and focused on making things. I'm a maker, so this would be a good program for me; I do make jewelry, after all.

I arrived at the museum on Friday afternoon with a friend (although I would have gone to the event solo), and from the instant I arrived, every single person I met was friendly.

But the participants were also interesting. And highly educated. And worked in Silicon Valley (with actual silicon). 
And made everything themselves. Which caused me to start to think, "who is going to take me seriously?"

I even had to make my own name tag at check-in

After Startup Weekend check-in (Friday evening), the fun and games began. New potential start-up ideas were pitched by about 1/3 of the participants. The best ideas were chosen by the group (90 participants total) and teams were quickly formed. Since I didn't have a specific idea or product to pitch, I had the flexibility to join any team. I found myself gravitating toward a scientific instrument based team for two reasons. 1. It was science (biology) based. 2. I met two electrical engineers signed up with the project and they were kind, welcoming, and funny. It was an easy decision; I had my group.

Slowly more participants joined the group until we became a team of eight. Eight strangers to be exact. We had a quick introductory meeting before getting down to business. I took a deep breath and looked around the room. Once again, I found myself sitting next to some of the most brilliant engineers, scientists (one of our members has a PhD in physics), and business consultants I'd ever met. And then there was me.

The tech creative process

The business development process

52 hours later, I found myself standing in front of a group of participants, museum goers, and very fancy CEO judges, pitching our final product; a hand-held, portable, low-cost, fluorometer. We presented last (not by our choosing). I was so nervous, I don't remember what the other 11 groups presented. We were the underdogs; the only team to barely pull together a company name in the 13th hour. The only team striving to create a low cost scientific instrument in two days. We were the team quietly operating under the radar, asking for coaching and advice at every turn.



                           From initial concept           to MVP (minimum viable product)

But then we won. The whole event - we were the judges choice and also the fan favorite. For once in my life, this left me completely speechless.

Victory

I can't believe how much I have grown these last three days. I know what a flouormeter does (and how it works inside and out). I know that the Spark chip inside our product runs on wifi and uses Arduino. I know that the product has wide ranging commercial use. And I know that I have skills that helped our team win. Plus, I know that I want to work with these people again. Simply put, I know that I met some incredible friends, colleagues, and mentors.

And I know that, at the end of it all, I care about making a difference. And I will continue to dedicate myself to service.

But also hopefully learn how to code.

Interested in joining a Startup Weekend? Check out the website to see if one will be taking place near you: http://startupweekend.org/

Thursday, July 17, 2014

emotional

emoji
a small digital image or icon used to express an idea, emotion, etc., in electronic communication.
"emoji liven up your text messages with tiny smiley faces"      

The word emoji means “picture letter” in Japanese. But when were these pictures developed? Wasn't it just yesterday I didn't even have a cell phone or computer? According to my lengthy web-based research, "although emoji weren't officially part of the Unicode Standard until 2010, the colorful cartoon symbols have been a major part of Japanese smartphone culture since 1998, when they debuted as a cute software feature on local phones".1 These guys date all the way back to the late 1990s.

What are these annoying little faces, hearts, and animal pictures found in all the text messages, emails, and Facebook posts I see? Why they're emojis, of course. But where did they come from? How did we get from no cellular devices to text messages filled with emojis?

The other day I received a text message from my mother, appropriately (right?) using an emoji.



Am I proud of her? For using an emoji? Not really. Because she is a writer. And because I am a writer. I rely upon the written word to convey message, tone, intention. I have written 20 blog posts in this space and have yet to reply upon the emoji. My mom doesn't need this picture crutch either. I believe she is witty enough to send her love without pictorially kissing me. That's okay, because I do use xx (an emoticon, see explanation below) to send her kisses. 

But it's when someone is trying to convey humor with a jk or lol or even a  that I think "really, that's all you've got?" I wish my texter would come up with some clever wording to express himself. If he did, I'd understand his text was not to be taken seriously. 

So is using an emoji a crutch? Is texting not supposed to be quick, easy, no thoughtfulness in expression techniques needed? I don't know. I suppose the answer is yes. But that only makes me dislike texting, along with the emojis, even more.

I only like emojis for their artistic value. I know this is strange. I don't value the emoji for its ability to wink at me with a cartoon character representation. I enjoy the facial expression that marks the wink.


Oh yes, I almost forgot: what is the difference between an emoticon and an emoji, you ask? Simply put, an emoticon is a symbol made with keypad characters. The ;-) wink I am a fan of (occasionally). 

An emoji, on the other hand, is a cartoon drawing of a face winking, the now present in many of my text messages. And, just in case you are new to the world of emoji, do not worry. There is an Emojipedia, to look up all meanings emoji. You can practice using them thanks to the addition of the emoji language keyboard on smartphones.


http://emojipedia.org/ has emojis for just about everything.

Now that you know what an emoji is, you can feel free to never use one again. No, not seriously. Promoters of emojis (cell phone companies) are pushing the benefits of emojis. "In a time of text messages with 140 or 60 character limits, and emoji being a single character, it could go a long way."2 This makes me sad.

References:

1. http://www.fastcodesign.com/3032434/where-do-emoji-come-from
2. http://www.iemoji.com/articles/where-did-emoji-come-from

Tuesday, July 1, 2014

anonymous


I have been applying for jobs. And before every job interview, whether initial phone conversation or in-person, I do some company research. In the past, this has typically involved looking at the company's website, reading more in depth about the job opening/qualifications, and taking a cursory glance at the staff member listing.
But recently I have begun to take my interview preparations one step further: I search out the person I am interviewing with. I not only Google the person, find him or her on the company webpage, and check out a LinkedIn profile, but I really look into the person. I find my interviewer on Facebook, read any article written about him or her, search for press releases, and even Google image search for head-shots. I like to know who I'm going to be speaking (and possibly working) with. I have gone so far in my due diligence that once I actually predicted a director would be leaving the company (I was interviewing to be her replacement) to go on to graduate school. When I mentioned this in the interview, she said I was the second person to make that connection. I guess my behavior is pretty normal.




Which is the main point my internet research is beginning to make clear; I will find out about you. When I worked at my former company, I would search for the current addresses of individual donors who had recently moved. Nine times out of ten, I would find the donor's new address, along with how much she paid for her house, the names of her children, and the city she was born in. I know that sounds creepy, but it was all just to send out an annual appeal letter to the correct address. I did develop a reputation among my co-workers for being able to find anyone, though. But that's because it's easy to be found.
And it is now the norm. I remember interviewing roommates years ago. I'd search out each candidate on social media sites. The same thing was true with someone I was going on a date with, or even with simple acquaintances. I now try to limit my internet stalking for job interviews, as I cannot confidently enter into the interview unprepared. But we all know that being given access to someone's complete and legal name is a free pass to search out the person via Google.




I used to think that it was possible and easy to live off the grid. If you don't want someone to find you, stay off the internet; don't join any social media sites and don't give your name to articles/quotations that may be published about you. While I welcome comments on my blog posts, beware of publishing anything with your full name. You never know what I might (and will) find about you.

I just found out that "off the grid" no longer means what I thought it did; "off grid" now refers to the millions of people living locally. Off Grid is one, among many, such website that includes various bloggers giving tips on how to live locally. Except in the state of Florida, where living off grid illegal. All homes must now be connected to a utility grid. This means all residents must be connected to a system and pay into this system. No more hiding in a cabin the woods, or not having a physical address to receive mail and bills. Everyone leaves a footprint. And there are millions of us on the other end, tracking it.

Not to scare you. I only use my internet stalking powers for good. To get to know you before meeting you and trying to convince you to hire/date/live with me. This is completely normal behavior; and actually, almost to be expected. Almost.


So while there is a fine line between cyber-stalking and conducting research, every single job search website lists researching your interviewers by finding bios and social network links as a "must do." Idealist, Monster, and Indeed specifically recommend, "You may find bio pages or press releases that give you insight into their most visible activities at the company. Then look to LinkedIn or do a general Web search to get some more background information about them." That looks like a green light to continue preparing myself in this fashion for upcoming interviews. But perhaps I'll put my default to research everyone mentality aside. And let real life people show me who they are.

To read more about acceptable job interview preparations, check out: http://career-advice.monster.com/job-interview/interview-preparation/interview-company-research/article.aspx