Constantine Gabriel

How to live with GERD

Getting my prokinetics won't be easy, but it will be necessary.  Not sufficient, however, because living--and getting a completee night's sleep--with GERD caused by intestinal dysmotility requires following two rules:

1. Digestion takes time
2. Don't eat napalm.

1. With prokinetics, and for people with a normal digestive system, breaking down food takes approximately 3 hours. Thus you have to stop eating solid foods three hours before bedtime or you won't be getting any meaningful sleep. Stay up, walk around (it helps to move your middle), and then go to bed.  Not before.
However, if you stop eating too much before that--say another three hours--you have a different problem.  Ever go to bed hungry?  Hard to sleep then too.  I get a burst of energy at that point which doesn't allow me to sleep at all.  What do I do?
Drink milk, eat a little ice cream, even drink a protein drink.  Since intestinal muscle is the issue, liquid nutrition is basically safe inside of those three hours. I can even get away with a glass of milk right before bed, for my Nexium.

2. Napalm, as I understand it, is a mix of laundry detergent (or some other gel-like substance) and gasoline. One sticks to you, the other burns you.
Think of the gel as fatty foods.  You can have fried food--i certainly do. Sangyeopsal aka Korean barbecued pork belly?  I eat it all the time.  Bread dipped in olive oil?  Bread is slow to digest, but as long as I don't eat it too late I'm fine. Greasy hamburger? Oh yeah.
You can have spicy food.  Chicken habanero that sets your face on fire?  Oh yeah--as long as I have plenty of tortillas and water--I love it, but I'm a bit wimpy that way. Pineapple or tangerines, those acids?  No problem, especially early in the day. Kimchi?  Sure, why not?
Utterly off-limits, however, is chili.  Spice + fat = culinary napalm. Curry will tear up my insides for days. Pizza--provided it's not particularly spicy, and as long as it's washed down with Diet Coke or Pepsi.  Not sure why the strong acid cuts through the cheese and dough, and I won't guarantee that one. Chocolate ice cream?  A little iffy.

This brings me to another oddity (besides pizza + cola).  I'm a coffee addict, the type of person you just don't talk to until I've had my daily mocha. The rule of napalm is very important in this one, because coffee itself is a strong acid.  So no milk, right? Au contraire, the milk buffers you from the acids. Dilutes them?  It's coffee's native oils that tear my gut apart.  I can't have drip coffee because of those oils, and I don't even risk cold brew. Espresso, however, does not let most of those oils through.  With milk, I can drink that all day.

Two simple rules, and two simple medications, are what's between me and a normal life vs constant heartburn and lost sleep. Thank you Korea for teaching me that.

cat under stars

For the students in Lovington and Yamagata

Greetings from Pohang!
I got the first batch of letters to Lovington written, but it will be at least two weeks until I have them all. Some of that is the schedule; 3rd grade has tests next week, 2nd grade has a field trip this week. Some of that is just the hectic schedule of life at a school in Korea.
Classes here start with homeroom at 8:30 am. Students get here by public bus, cars, bicycles, on foot, or by academy bus. Those are also the ways they get home after their last class, most days at 4:30pm.
What's academy? They're sometimes called "cram schools" because they're there to help you cram for the big exams. Test scores are a very serious thing here and have been for hundreds of years. Your exit exam for middle school decides what high school you go to, decides what college you go to, decides what career you can get into. If you only study at school you might do well on it, but parents don't take chances. You go to school after school.
Korea actually had to pass a law that said academies had to be closed by 10pm, because some of them were open later.
All this hard work gives South Korea some of the highest test scores in the world but some of the highest stress in the world. Next entry I will tell you some ways they cope with that stress.
from ROKetship
cat under stars

Lasek 2, day 8

Oh what a difference.  Yesterday I had those damned bandage contacts taken off--gawd how I hate those things.  My right eye had a residual itch for a little bit but that was all.  Still wore--wear--a hat when I'm around air conditioner vents, which in this country are typically on the ceiling.  Sunglasses and hat whenever I'm outdoors, but my energy levels are like I was never in surgery.  Such a tremendous contrast from last time.

Tonight I went biking, after dark.  I had safety shields i.e. clear plastic goggles just in case, but didn't use them.  I was careful on the way to coffee, and it's important to note that I stuck to familiar paths for the most part, but only mostly.  I'm careful.  Still, I could see well enough without any assistance at all to ride up and down the trail, to and from the riverside, and to read the newspaper off my tablet even without large print for the duration of a coffee and ice cream. The reading was difficult as it is at the moment, but it's doable.

I waited until after this workout to shop computer glasses, because I know exercise affects eyesight.  I have a lot I want to get done on the computer or I wouldn't bother shopping for them at all.  My close sight is functional.  My far sight, which still bedeviled by the occasional starburst, is...well, life is beautiful, visually.

cat under stars

LASEK "touch up"

So I went back under the proverbial knife because my vision had resolved to slightly nearsighted, the one outcome of the initial surgery I was not willing to live with.  Sure, reading was effortless and I could see the person I was talking to when they were across the table, but what I couldn't do?  I couldn't clearly see sunsets, skylines, signs in the hallway telling me where to find things, or on bad days the face of the kid in the back of the classroom.  I couldn't ride my bike safely at speed or in low light, nor drive a car without glasses. This would not do.

It's day 4 now, and until I checked the calendar I'd have told you day 3. I can read the computer screen now, with the font a bit large and not for long periods of time, but that becomes steadily easier with time, as does my tolerance for wind and light.  Even so light sources still give me those adorable little spider webs, arms like starfish and concentric circles running about 8 or 9--attempt to count them and then shrink, likely with focal point, so I can't give an exact number.  I'll draw them...possibly today.  I'm going to try pen and paper to see if the relatively low contrast makes that easier to read despite font size.

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loki

Dental implant and LASEK part 10: The final stretch, I hope

So I go to the eye doctor two weeks ahead of schedule because I'm flying to LA tomorrow and was concerned that all my starry special effects were going to impede my driving, and LA is one town where you need to be tack-sharp to drive. LA drivers, while not fond of unnecessary risks, drive fast and aggressively and you need to see them coming.  So I go to my doctor and tell him I'm nearsighted and that I'm seeing these double images at light sources...

Why did nobody else tell me that this is pretty much how nearsightedness works?  I haven't been appreciably nearsighted in twenty years and just don't remember that!  The doc indulged me a pair of glasses for driving, and the optometrist/assistant warned me not to wear them too much as they could give me headaches.  It's really, really cool being able to see though.  It has also allowed me to realize that distant building lights have starry special effects even for people with normal vision.  Again, why does no one mention this?

What's funny is the reason the doctor gave for why I'm still nearsighted at the six month mark.  Remember, farsighted eyes like mine have to be overcorrected because the naturally try to revert to their old shape.  The doctor tells me that some UV exposure is needed to nudge that process along.  Apparently my Goth-inspired habit of wearing a black corduroy hat all the time and otherwise avoiding UV exposure liike it's nuclear radiation has slowed my process.  No more hat, he says.  But where will I pin my Narrative Clip camera?  Oh the irony.

I complained about how my eyes get dry which hurts their focus even more, and the doc suggested a hot moist towel before bed.  It works, and it feels lovely besides.  I no longer wake up in the wee hours wanting eye drops, and my eyesight in the morning is better than I remember it.  Of course part of that is brain perception--understanding that all the Air Jordans and Jim Carrey ballerinas aren't an artifact of the surgery so much as a function of myopia drops my anxiety levels over them considerably.

Anxiety that now focuses on my tooth.  Also ahead of schedule to accomodate my LA trip was completing the implant process.  They screwed the bolt in the socket, fitted the coffee-stain colored zirconium into the space, and cemented it down over the screw-post.  Yesterday it felt fine, minus the usual post-dental sort throat.  The day before my right throat gland was swollen, as it had been for some days.  This morning I woke up with a cramp in my jaw and the new tooth sitting too high in its place, so I went to the dentist who kindly filed it down for me.

Right now my whole upper jaw is complaining, and I have a plane to catch tomorrow. The drill thing that filed down the tooth made a breathtakingly awful noise and I'm sure it offended all kinds off bone-tissue in my mouth.  The interdental brushes--which are de rigeur for this kind of implant--slip a little too easily in the gaps next to the new tooth.  The cold coffee late this morning felt awfully cold.  Is this my anxiety over my trip ahead, or is there really an issue?  Or is the bone just offended and it'll be fine in the morning?  Or worst--will things suck badly enough in the morning to make me miss my flight, or will going up in an airplane make everything horribly worse?

I'm far too good at building these mental snowballs.
misty

Eye surgery and dental implant part 9: boredom punctuated with annoyance

Eyes still seem nearsighted, though it's something to kvetch about more than anything.  I'm able to ride my bike at the ordinary (not bat-out-of-hell) pace that I used before surgery, so that's something.  Night riding is still scary, especially since oncoming bicycle headlights give lovely starbursts that preclude seeing the rider of the bike.  Why would I need to see that?  To know whether the rider is distracted, or whether they are gesturing to me with their head.

It's month what, five?  I worry that my far-sight is not coming back, so I make a point of more riding, to work on the distance muscle tone.  Will it be enough?  I don't know.  I'm hoping to visit home in two weeks and difficulty driving would make that rough.

My neck is kinked up good from repairing the cat scratcher with a hot glue gun, and that can't help.  I don't feel it in the neck itself, just in the numb spot at the tip of my right thumb and the overall wandering tension in my back.

Dental though...oh joy.  Got the abutment put in tonight.  The Novocaine shot went rapidly in, the doctor made the incision that didn't bleed much relatively speaking, and the sensation of a screwdriver in my mouth was almost amusing.  The stitches were no fun, but with Novocaine they were no big deal...until it wore off, and it wore off pretty fast.  I went to the grocery store next door to pick up something soft for dinner and...wow.  Like papercuts from Hell, the pain seemed mostly on the surface but was irritated every time I swallowed. Mild nausea.  It's possible there's pain up further but I've studiously avoided putting any suction in that area.  Quite possibly that irritated it at first.

I took a Midol-like painkiller a few minutes ago so I wouldn't have to deal with the paiin, so I'm not trusting my memory on the gum-bone pain.  There's a slight taste of blood.  Happily I'm not hungry, and I've got a gallon of milk in case that changes.  Time to sit back and enjoy my recliner and cat.
loki

Dental implant and LASEK part 8: Is that a Paxil in my pocket?

No, as it turns out.  The dentist was honest with me in telling me that it's a muscle relaxant, Sildalud by name.  I wasn't scheduled to go in to the dentist but I was getting pains in the molars surrounding the implant and didn't want to take any chances.  After all, if I hadn't ignored teeth shifting around on that side for as long as I did we might have caught the matter earlier.  Early enough?  Good question.  But the mere worry of that tooth implant going bad again is enough to scare me, and I wouldn't blame the dentist for dosing me with an anti-anxiety drug, I really wouldn't.  But he didn't.

I'm now more mindful when I go to bed to pull a blanket up over my neck and jaw.  I caught myself chattering just before falling asleep and am reminded that when I'm cold I do clench my teeth, conscious or not, and that this was the likely source of the pain.

Eye doctors I'm less impressed. The eye chart tests came in 20/20 for the right eye and 20/15--slightly farsighted--for the left.  This is a desirable outcome even if it means the eyes are uneven and they definitely were that day.  My disappointment, though...the doctor was pulling off his scrubs when he came to the office to talk to me and I remarked on that, how busy he is.  He is.  Most Korean doctors are tell you the truth, though I understand that's doctors period.  He was mildly annoyed at the left eye gone farsighted because he apparently confused me with a patient who got monovision (that is, left eye corrected to nearsighted for reading, right eye to far for other tasks, an approach I refused).  I know you're busy, dude, but my charts are right there and "Reading glasses okay" should be prominently on that chart.  Farsighted my ass--I was nearsighted and knew it, though the results made me question that.  Definitely double vision though, as the eye chart is black on white and digital besides, making it the high contrast that my eyes 'love'.  That was November 19th.

So last weekend I go to my old optometrist/sunglasses connection and I manage to talk him out of a simple exam, no glasses at all.  Surprise surprise, -0.75 in both eyes--nearsighted. I realized this most strongly when I was riding my bike home Friday and failed to recognize a close colleague in the market until she was right on top of me.

I'm biking again but careful to do so when the light is good and my brain not otherwise occupied, so not as often or as far as before.  My muscles are not happy with this, but they need it, my lungs need it to finally clear this allergy/infection crap, my heart needs it, my mental health needs it, and my eyes definitely need the workout.  My temples are still achy from Friday and Sunday's rides, compounded by deliberately doing far focus when I was walking last night and this morning.  Aware of the ankle traps in this country, I only do that when I'm quite confident of what's underfoot but that's basically the walking route home from coffee so it's doable.

Oddly this morning I forgot my steroid drops before leaving the apartment so decided to take them when I got to my destination.  Was it my imagination, or was my distance vision better this way?  Things five or 8 yards away were clear where last Friday--evening, to be fair-- I only had clarity at two yards. I should go take a walk and test this hypothesis.  Here inside the office though, nope.  The ficus at five yards has a glamorous soft focus to it. The library stairs outside in lovely natural light are only almost in focus.  A gray day--light level matters and contrast matters.

It's important to note that contrast matters more than light when it comes to ghosting.  Closeup, nothing ghosts anymore.  Okay, this screen as I type has tiny ghosties but I hardly see them. The calendar in my cubicle they come and go  (reaches for eyedrops since dryness affects this, and computer screens discourage blinking.  Sodium hyaluronate, yum.  It's actually the good stuff, since I appear to have left my mere Artificial Tears at home.  Yes, of course I have a backup with me, but it's hermetically sealed)  This momentarily makes the ghosties worse, like when you're crying and your vision goes to shit. The ficus is only slightly clearer. The library stairs are paradoxically less clear. The ghosts on the calendar go away when I close my right eye.

Yes, all of this is annoying, and had better go away by spring.

Meanwhile nights have gotten less sparkly.  Plenty of starbursts and black rainbows, these things I'm okay with.  The Air Jordan logos now look more like ballerinas, more horizontal than vertical.  There is a definite difference between each of my eyes, but I don't recall which is which. One catches star-ray distortions, the other gives me glorified ghosties.  Progress, but not enough.

This had better all go away by spring.

Some pictures.  I find this one interesting so I'm putting it first.  The vision simulator says this:
"Vision Quality Disparities:
Patients with bilateral eye injury or LASIK complications may report different aberrations in each eye. With both eyes open, these aberrations are synthesized to yield a composite image. However, one eye usually contributes more to the resulting composite than the other, a phenomenon known as "ocular dominance." This simulation illustrates one possible scenario, in which vision in the left eye is blurred following LASIK, whereas vision in the right eye is ghosted. Drag the slider right and left to control the degree of ocular dominance between eyes. The default if set at about 75% in favor of the right eye, reflecting the fact that for most individuals, eye dominance follows handedness."

Note where I've set the slider, towards the blurry eye and away from the ghosted one. That's my vision under good middling lighting conditions.

Here are my ballerina starbursts, roughly.  It's very hard to get an accurate version of this since it seems to combine starbursts and ghosting.  Also the really cool starbursts have a webby quality that the simulator does not include.


And finally the ghosting.  Only in high contrast situations, so it's not as bad as this picture makes it look.  The photos on the menu, for example, aren't that bad.  The text definitely is.


Now to get some work done.
cat under stars

Dental implant and LASEK, part 7: this is getting annoying

I had a shot of whiskey in my evening coffee, so I'm feeling a bit whiny tonight.

Two weeks ago after playing around all weekend (and not resting) I got what could have been a cold.  In this case it seems to be a seasonal allergy, my body's response to dry indoor heat and falling leaves.  I called the eye doctor's office to see whether there were any medications I should avoid and the answer was no, nothing contraindicted by my eyes.  At three months I'm beginning to feel like they're just another part of my body now, something that, outside of the hat and sunglasses, don't take any special precautions.

The trouble is they're still nearsighted.  Sitting at coffee tonight--mind you, spiked coffee--the light bulb in the fixture above me was so clear I could almost read the print on the bulb, had I wanted to fry my retinas staring at it long enough.  Fully focused, no doublt images, approximately two meters from my face.  Across the room, however, came and went focus-wise.  Looking out the window into the garden and the after sunset colors were simply gorgeous but the lines between the green leaves and dark blue sky were not at all clear,  High contrasts items are even worse--the white pillow on the burgundy couch a mere three meters away produced a ghost image, but only if I focused on it.  Starker contrasts don't require such focus;  the hospital signs are still in doubles.

Nights--the satanic starfish are now less guy-on-fire and more like Air Jordan logos with tiny little jazz hands.   That's an improvement, right?  The moon the other night, though...I seriously wish it had been possible to photograph what I was seeing.  It was an orange crescent moon, just a sliver, but with my distorted visionn it looked as though it was leaping out of bed, a main image with two ghost images suggested someone getting up.  I wished I could see the unduplicated moon, but I also wish I couldd have photographed the leaping illusion.  Too bad.

Last appointment my right eye was 20/15 andd my left 20/25.  Neither doctor nor optometrist was concerned, but I know my own eye history.  As a child I had lazy eye and to this day my brain rarely uses both eyes, creating minimal depth perception.  My left eye may be slacking off.  I put a paper patch inside one pair of my sunglasses and wear those to and from the cafeteria, where I don't have to worry about tripping over anything on the pavement.  It is disorienting but it gave me nice sore temple-muscles on the left side so I may be on the right track there.  We shall see.

I remind myself that it's only been three months and that this can take uo to a year, but I'm also hoping to go home for good this winter which would make touching up a real problem.  I just hope I won't need touching up.

The implant gets looked at once a month like the eyes.  The new crown settled in and is easily forgotten, but the allergies had me worried.  Can I be sure those are allergies, and not a complication of the implant? 99% sure, but the sinuses are awfully close to all that.  Every little grumble on that side of my mouth makes me worry, and sinus pressure does push around the teeth on either side of the hole.The initial infection I mistook for unseasonable allergies, so I worry.

cat under stars

I need to update my LASEK thing

For now, though, I'll attempt to illustrate the "satanic starfish".  Here is from the vision simulator:



though the arms have a curving way about them.  Imagine this stick figure with the light effects from above, and you understand what I see any time there is a bright point of light against a dark background.  This is only with *points* of light--signs and the like get common ghosties.



Giving speaking tests, pure headache with glasses, is easy while giving them.  I can read name tags clearly, see the kid's face clearly, and read my paperwork with reasonable clarity.  Afterwards, though, my eyes are dry and tired.  Part of giving a speaking test is giving a facial expression that projects friendly listening--eyes open, body language open--and that'a harder than it sounds. 
death note

Dental implant and LASEK, part 6: roll with the changes

Because of the holiday I was able to take my bicycle out last Wednesday, on to the river trail that is fairly recently built and, as I would discover, had the previous holes in it filled (holes being gaps where they were installing drains).  It felt great, great enough to put in just over 11km total.  Damn I had a pent-up need for the road.

Alas, any need for speed remains pent up.  Riding like that requires fine focus at a distance which just isn't there yet, at least not around the dusk hours.  I had to keep my speed at about 11 kmh in order to see pebbles and the like in time to avoid them, really frustrating since I prefer to ride about 18-20 kmh on the river trail, 15 or 16 on roads, and those speeds were just a very bad idea.  Even slow I misjudged a turn and ended up on a knee and an elbow, barely scraped but still humiliating.

Dusk is a nice time, since UV is not an issue and lights aren't doing their special effects just yet.  The special effects' novelty has worn off and now they're mostly annoying.  Starbursts are increasingly rare, showing up mostly when I look directly at a bright light source.  Even then they're usually hazy rather than spiky, circled by a rainbow, much like before the surgery.  Not every light source does this, though, which is a shame really.  Not only is it pretty, it's less annoying than what I do get.  I call them Satanic starfish.  Most headlights and tailights do this, a five-pointed star with one point down, not symmetrical.  Looking at the Christmas lights I keep in my apartment, the ones at my feet do this but the ones close up are starbursts. This suggests to me that the starfish are a function of wrong focus rather than double images but I just don't know.

Ghosts remain a problem.  I'm getting them as I type now, though with a small black font on a white screen.  If I magnify the screen...there...they seem to go away and I catch my typos.  Looking for them though they are there even at this size, just easier to ignore. Contrast makes them worse, low contrast and they're very nearly gone.

I mentioned faces last time, but I no longer notice them.  Has focus improved, or has my brain simply started working around that?  It's significant that eyesight is as much brain as eyes.

A checkup on Saturday, and sadly I won't have time for one more bike ride.  That would give me a sense of how much distance vision I have as well as improving it.  A ton of train time last weekend gave me hours to work on my distance vision and I felt it helped.  Just now, after a long day at work, my evening paper taken by an open window (around sunset and not in direct light, but cloudy meaning I had no real sense of UV exposure), my eyes are dry and just not up to playing around.

A link to explain ghosting and starbursts. http://www.visionsimulations.com/simulations/

Got a second opinion on the other molar that needs capped and yes, it needs recapped dammit. The implant isn't causing any troubles directly, but there's a pressure under my nose on that side from time to time that suggests my maxillary bone has not forgiven me yet.  I worry that the dentist did not get all the infection out, but other than that pressure spot there is nothing to indicate anything wrong at all. I did get an itch up in my nose, at lunch time today as well as just now when I poked at the pressure spot.  Deliberating inhaling a little bit of water fixed that at lunch time so it may in fact be a thing in my nose and not at all related to the implant, I just don't know.  At least in the mirror everything looks in order, and the second opinion dentist did not see anything worth commenting on.