Hmm, if I want to play it safe, it looks I should forego the rare steak for the time being, and just go for a coffee and beer diet. I think I can handle that.
Chocolate helps the brain, too. It also helps athletes to recover after performances and, of course, does good things for the heart. Wine has loads of anti-oxidants. Oh, yeah: if you throw alcohol on top of fruit, it increases the antioxidant power of said fruit (here).
It seems that no one is taking this terribly seriously, which I think is right given what appears to be relatively weak evidence. (I suppose there is no reason to suspect bias in the BBC's reporting on a subject like putative health benefits from caffeine. But then there isn't much reason to suspect bias when the BBC reports on certain world affairs subjects either, because with those it practically leaps out at you.)
It seems that no one is taking this terribly seriously, which I think is right given what appears to be relatively weak evidence.
Just to be on the safe side, I think I'll invest in a cappaccino machine. After all, lawyers have to take care of their brains like prostitutes have to care for their bodies - tools of the trade, etc.
After all, lawyers have to take care of their brains like prostitutes have to care for their bodies - tools of the trade, etc.
By "brains" you no doubt mean the organ which sits inside the cranial vault and directs most of what we do. My wife, though, maintains that males have what amount to smaller, auxillary if you will, peripherally placed "brains" that direct some of what their possessors do. She attributes Eliot Spitzer's downfall to his allowing that smaller, peripherally placed "brain" of his to take control at times. So it may be that professionals, both those with and without advanced degrees, whether admitted to the bar or merely sitting at the bar, should not only take care of the "tools of the trade," but also take care that they are deploying the appropriate one.
Neurodoc: being female, yes, I was referring to that brain - presumably, the one that is the focus of your professional career. (If you have a side job as a gigalo, I don't want to know about it.)
* Dr. Melik: (listing items Miles had requested for breakfast) "... wheat germ, organic honey, and... Tiger's Milk."
Dr. Aragon: "Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties."
Dr. Melik: "You mean there was no deep fat? No steak or cream pies or... hot fudge?"
Dr. Aragon: "Those were thought to be unhealthy... precisely the opposite of what we now know to be true."
Dr. Melik: "Incredible!"
SenatorX: After all, lawyers have to take care of their brains like prostitutes have to care for their bodies - tools of the trade, etc.
Well there, we have something in common, the misery of GERD, or gastroesophageal reflux disease. I used to think it a banal problem, but since I developed it myself, I no longer think it a banal issue that my lower esophageal is lax or frankly incompetent, and relaxes further in the face of particular foods and drinks. (theobromophile, you especially should appreciate how terrible it is for chocolate to be the most certain trigger of all for the unpleasantness of GERD.)
SenatorX, to start with, I presume that you taking a PPI (proton pump inhibitor drug, e.g., Nexium, Pepcid, etc.), and that you are taking it correctly. (I thought once-a-day meant that I could take it nightly at bedtime, until my gastroenterologist told me that that was exactly the wrong way to go about it. Best to take it in AM after an overnight fast, then follow with some protein intake.) If you aren't, then you are denying yourself the relief that a PPI can give.
Next, "chocolate" to be sure, highly effective in bringing on reflux. And "red wine" works for (against) me too, but I think it is alcohol in general rather than just red wine. I can't say anything about coffee or cafeine from person experience, because I rarely drink it. "Fruits" puzzles me, so would you say which ones in particular may have caused you problems. (I expect there is a fair amount of variation from individual to individual in what provokes their symptoms, though some things may be common to all, e.g., chocolate.) Almonds is another of the things I should avoid at night.
But SenatorX, do you have much of a problem during the course of the day, or like me, do you have your problem principally at night, maybe an hour or two after you fall asleep? (I wonder about some connection between sphincter tone and the stage of sleep, but I don't think the necessary study to establish or rule that out has been done.) If it is a nighttime thing, can't you have those things provided you don't have them within hours of retiring. (And provided you don't eat alot before retiring too, since I think large intake no matter the composition is another thing to avoided in order to avoid the nasty symptoms.) I won't suggest shock blocks under the bed, or even sleeping with many pillows, because I think that of minimal benefit for most people.
Finally, have you been endoscoped from the north (gastroscopy) as well as the south (colonoscopy), the latter if you are more than 50 years old? GERD is usually just a terrible, unpleasant nuisance, unless it leads to aspiration pneumonia, but in susceptible individuals it can put them at heightened risk for cancer of the esophagus.
I suppose that the drug companies are happy to make the many billions of $s that they make with PPIs and consider that to be the pharmacologic agent. I wish, however, they would look for something(s) that would block whatever it is in those foodstuffs and drinks that aggravates the GERD by causing further sphincter relaxation, and hence incompetence. (It must be more than one component, however, since I don't think alcohol and chocolate have anything in common, other than the pleasure they can give.)
As for the second smaller male brain, we all know it is ruled by alcohol and if you have enough alcohol it rules the other brain completely. No amount of caffeine will protect you from that.
Another good thing about coffee: Back when I was training for marathons, I learned it promotes fat-burning in the muscles during prolonged exercise. It works so well, in fact, that it's prohibited above certain levels for Olympic-level athletes. But the rest of us can stoke ourselves as much as we wish.
I also have GERD (doesn't everyone?). This is the first that I've heard one should take the pill in the morning. PPI seems to work for me taking it anytime.
I've found that my GERD condition is extremely sensitive to weight. Even a gain of 4 lbs significantly increases symptoms. I can bring the symptoms down to the point where only occasional use of Zantac is needed by losing enough weight.
Everything gets better when you lose weight. BTW I was not overweight to begin with. Of course "overweight" is defined as a BMI >25. That's wrong. It's really BMI >21. Twenty five was a political compromise.
I won't suggest shock blocks under the bed, or even sleeping with many pillows, because I think that of minimal benefit for most people.
Back in the day when meds were more primitive I once encountered a similar solution that worked, or so claimed the proponent and GERD sufferer. It's not for everybody though. He was a long distance yacht racing enthusiast. His solution was to construct a bunk at approximately 45 degree angle from vertical, and lash himself to it for sleep.
Mormons live fairly healthy lifestyles which may mask the effects, but it would be interesting to try to see if these coffee-eschewers suffer disproportionately from Alzheimers.
I wonder if anyone can confirm or deny my impression that GERD is an American disease, caused by our lifestyle or eating habits. One sufferer I know developed it in her early 20s, and does sleep in a bed whose head end is elevated several inches.
I sincerely hope that, by the time I would get GERD, some brilliant scientists would have found a cure for it.
Dairy is supposed to promote weight loss, and, of course, prevent osteoperosis (sp?). Ergo, my lunch (chocolate frappe) is obviously a health food, one which will prevent the onset of GERD. Right?
In case anyone was wondering - blood pressure is about 90/60, cholesterol is something like 135, etc., so I'm obviously doing something right.
Theobromophile: I hate to be the bearer of bad news, but based on those number, you chance of dying is 100%
Oh? thats not how correlation works? Sorry!
Houston Lawyer: As for the second smaller male brain, we all know it is ruled by alcohol and if you have enough alcohol it rules the other brain completely. No amount of caffeine will protect you from that.
What you have said about the effect of alcohol on the "auxillary" brain of males, something females lack, is unquestionably true. You neglected a significant point, however. The alcohol effect is dose dependent. At lower doses (I don't have blood alcohol levels to give,) it may have a disinhibitory effect on both the "big" central brain and the rather small peripheral one, promoting risky behavior, while not causing other non-impairing effects. (Spitzer was acting with pre-meditation, so can't blame alcohol for his conduct.) But with higher doses (DWI levels or beyond, depending on the individual?), the desire may be there but the ability to perform as intended may fall off, even to the point of total failure. (I think that Shakespeare somewhere alluded to all this, but I don't have a cite for you on it.) Because women don't have the functional limitations imposed by the "auxillary" brain, they are certainly subject to alcohol's effects, but it need not affect performance nearly as much as it can the male of the species. Some unprincipled men will ply women with liquor to get the disinhibitory effect, but the disinhibitory effect is so easily achieved in men, that women of even minimal desirability don't have to ply men with drink for this purpose. (And women are more inclined to focus on longterm objectives vis-a-vis men, whereas men often find it hard to think longterm, especially with alcohol on board.)
I expect you knew most of that, but I thought to serve it up in faux-medical terms.
She knows she is going to die like all of us mortals, she just wants to live long enough to pay back her student loans.
Actually, neurodoc, I'm waiting for a federal bailout for students who made unwise borrowing decisions, gave no proof of income, and expected the market to keep improving.
Fub: His solution was to construct a bunk at approximately 45 degree angle from vertical, and lash himself to it for sleep.
Yes, a solution for him, but not one that would avail me. I am one of those unfortunates who cannot sleep except fully extended flat, preferably in the prone position. If it were otherwise, I would not suffer so on red-eye flights and other situations in which the desire to sleep can be very strong but there is no the opportunity to stretch out flat. Upright at 45 degrees wouldn't work for me.
A. Zarkov, I expect that some weight loss might help me with the GERD, and perhaps the obstructive sleep apnea too. And it remains my intention to try it one of these days. Interesting that you say so little change in your weight can have notable effects on the GERD symptoms. Are some things, e.g., chocolate, or habits, e.g., eating a lot within a couple of hours of retiring, especially provocative of symptoms for you? Have you ever been gastroscoped? (GERD seems so banal a disorder, but it can cause changes to the distal esophagus that set up those who have it for cancer.)
The PPIs do a good job of what they are supposed to do, which is block acid production and cut down the volume of stomach secretions. I appreciate the fact that we can turn to them. But cutting off acid production doesn't mean that stomach contents can't reflux up the esophagus when the lower esophageal sphincter isn't working up to snuff to prevent that back flow. (I expect GERD sufferers know all this from their own experiences.) Being disciplined with respect to one's habits can make a big difference, but easier said than done for some of us.
I think that Shakespeare somewhere alluded to all this, but I don't have a cite for you on it.
I'm pretty sure it's the gatekeeper in Macbeth who says that alcohol "increaseth the desire but taketh away the performance." All off memory, so disclaimers apply.
I keep waiting for my cocaine and brown heroin, not white, that would be unhealthy, diet to win favor, but alas it has not done so. Somehow I soldier on!!!
I'm pretty sure it's the gatekeeper in Macbeth who says that alcohol "increaseth the desire but taketh away the performance." All off memory, so disclaimers apply.
Good memory.
Macbeth, Act 2, Scene 3:
...
MACDUFF:
What three things does drink especially provoke?
PORTER:
Marry, sir, nose-painting, sleep, and
urine. Lechery, sir, it provokes, and unprovokes;
it provokes the desire, but it takes
away the performance: therefore, much drink
may be said to be an equivocator with lechery:
it makes him, and it mars him; it sets
him on, and it takes him off; it persuades him,
and disheartens him; makes him stand to, and
not stand to; in conclusion, equivocates him
in a sleep, and, giving him the lie, leaves him.
Funny I also have sleep apnea, and yes weight loss helps that too. Yes I have been gastroscoped, twice in about 10 years. I asked my doc if even a small weight loss can have a noticeable effect and he said, “yes” without hesitation. Managing what and when I eat does control symptoms as well as using Gaviscon once in a while. I suspect that if I can lose another 15-20 pounds the GERD will improve significantly and that will put my BMI at about 22. Weight loss can be done if you log your total caloric intake and get a lot of aerobic exercise. Weight training also helps increase muscle mass, which can reset your metabolism. I use an EatSmart food scale, which has a built-in database of calories. You punch in codes and then just put food on your plate until you hit the desired calorie level. Without an objective measure of how much you’re eating it’s very easy to fool yourself.
I am taking Nexium in the morning when i wake up and waiting 1 hour to eat and lately I have had to be very restrictive on what I eat or it triggers it again. Before I realized what was wrong with me it had gotten very bad actually and it really is amazing the kinds of pains and issues GERD can cause. I was pretty sure I had gallstones or cancer for a while as the pain in my abdomen, side, and back was also combined with odd lumps I would find on my stomach. The lumps however go away within a day and my umpteen blood tests all are good. The doctors have no idea about this symptom and really it took 4 months, x-ray, ct, sonogram, and MRI before they referred me to a gastro. All the tests found nothing wrong while I am laying there in massive discomfort day after day.
I think I am getting control of it but I probably will request some GI scope just to be sure because it still is bothering me with weird pain in my side that moves around. What makes it worse for me is I also have a chronic kidney stone problem (passed something like 12 stones so far) so I am on a low/no oxalate diet too. That complicated the diagnosis for GERD as they all kept pushing it was kidney stones even though I kept telling them that it feels completely different.
Right now all I have is room temperature water all day long, nexium, a bagel in the morning, some humus and whole wheat pita for lunch, and a small piece of bland meat with some veggies for dinner. This works though and is better than being in pain all the time and feeling like you are going to die soon. I also started working out again and an added benefit is the weight loss. I definitely think weight has something to do with it but the food types even more so. I was drinking lots of coffee for a while (5-6 cups a day) and I also discovered tomato sauce of any form (which I love) is a major killer. Hard candies are good though for saliva generation helps and I just started adding fish into my diet again which seems ok.
GERD has a silly sounding name and it seems like a common problem but it really can cause serious quality of life problems if you have it.
SenatorX and others, I really didn't mean to offer myself as an expert on GERD, because I certainly am not, just a fellow sufferor. But since we have started this, I will say just a bit more:
Infants can have this, and it may look like seizures, because they suddenly stiffen, extending (retroflexing) their back and neck in response to the terrible burning sensation when stomach acid goes where it is not supposed to go, that is back up the esphogus, irritating the sensitive lining there (Sandifur's syndrome). Children with neurodevelopmental delay who can't be fed by mouth because they may aspirate what they are being given into their lungs, which is decidedly not good, get operated open
to allow feedings directly into the stomach by way of a tube (PEG), and with that the upper portion of the stomach is closed off to prevent the feedings from going back up the esophagus (fundal plication). There are procedures to remedy incompetent lower esophageal sphincters in adults with GERD, but according to my gastroenterologist, most fail within a few years, so no good answer in them.
I don't recall ever experiencing any GERD symptoms before one day a few years ago. We were in Padstow, England and ate at Rick Stein's excellent fish restaurant there. I had an appetizer of curried Spanish mackeral, and hours later, I had this most incredible, painful burning in my throat. Absolute misery, not something that could be ignored. When we got home and I went to see my GI doctor, I wanted to give him all the details of what I had eaten, the onset of symptoms, the subjective perceptions, etc., but he had no time or interest in all that and just pronounced the diagnosis of GERD with absolute confidence that this explained it, as it did. (When it is one's own affliction rather than someone else's, the details seem hugely important, while for my doctor GERD said it all.) I don't know how significant, if at all significant it was that I had had that spicey food. Spicey foods, when I eat them on infrequent occasions, don't cause me obvious problems, though they may do so for others, like the lady eating in the Italian restaurant featured in one of the Nexium ads. Chocolate is the most certain of provocations for me, so that a relatively small amount of it within a few hours of lying down to sleep almosts guarantees that I will be awakened by reflux.
Thankfully, I don't have Barrett's esophagus, those changes to the cells lining the esophagus that may set one up for cancer. That makes a fairly banal problem in to a definitely not banal one, poising a hanging sword over one's head, leaving them to wonder if it will one day drop. (I keep asking myself why I have this banal disorder, why my lower esophageal sphincter won't do the simple job assigned it, that is blocking backflow from the stomach. Then a voice inside my head asks me whether I would rather have a big league non-banal disease, one that would be much more "interesting" to colleagues than the stupid GERD that I have. The answer that comes immediately is "NO.")
I have no idea why people vary as to what provokes GERD symptoms in them, but it seems that they do vary in that regard. So, I can look at lists of what can bring on reflux and see that only a few cause me any problem. (Why couldn't it be just things I don't particularly care for that cause me this problem?!)
SenatorX, the Nexium should knock out the stomach acid production, though you might need another one at night to hold you. But knocking out stomach acid only means when your stomach contents reflux, you won't suffer the terrible burning; it doesn't mean that partially digested food won't come back up and cause you coughing and choking. I think that those things you find cause you acute symptoms are things that cause the sphincter to relax and allow reflux, rather than elicit acid production. But I won't speculate whether or not all that you report does relate to GERD.
Interesting that you mention hard candies and saliva production. At a party given by a fellow neurologist celebrating his elevation to a full professorship at a prestigious school, I encounter a gastroenterologist. Seeing this as an opportunity to learn something, I started telling him how my symptoms never came on soon after I fell asleep, nor very long after, but rather almost always about two hours later, leading me to believe that it must have something to do with the stage of sleep I was in, my theory being that the esophageal sphincter was just doing something physiologic in response to what was going on in the brain at that point. The GI guy, who had been asking the neurologists present about his father's unfortunate neurologic illness, told me it wasn't directly related to sleep, or not related to sleep in the way I had imagined. According to him, saliva production slows down or stops during sleep. Saliva has the pH of a base, so buffers acids. Thus, when we first fall asleep and for awhile afterwards, acid coming back up from the stomach gets neutralized by the saliva we swallow. But we stop making saliva, so after awhile it isn't there to neutralize the acid that is refluxing, and it is then that the burning comes on and we wake up with it. I'm not persuaded that it has nothing to do with stage of sleep per se, but the GI person is undoubtedly much better informed about these things, and his explanation is straightforward and entirely plausible.
So now, GERD sufferors arise, throw off your chains, and demand that the government do something about this!
theobromophile, I know you don't really mean it about looking to the federal government to bail you out on the student loans. Not only does your tone hint that you aren't serious about it, but we know that your libertarian philosophical principles would not allow you to accept that bail out if it were offered. But you would not willingly acquiesce to fraud, would you?
School financial offices must owe something of a fiduciary duty to those students who turn to them for help. Were yours on the up and up with you? Andrew Cuomo, who succeeded Eliot Spitzer (yeah, him again) as NY's AG, and is now eyeing Spitzer's last job as NY's governor, has targeted student lenders (and others) in the manner that Spitzer went after Wall Street. Through his efforts, we now know about shenanigans where student loans have been concerned, with those responsible for counseling students being paid off by the big lenders. Hopkins, for example, fired the lady in charge of their financial aid office when they learned that she had received emoluments from lenders, perhaps to the detriment of student borrowers. So perhaps now, with your now keener legal eye, you should look into whether or not you got the loans you should have gotten. To do so wouldn't cause you any libertarian non-GERD heartburn, would it? (Or is "caveat emptor" combined with "laissez-faire" the libertarian's fundamental creed?)
Does exposure to semen make women happy? Apparently so, according to the remarkable conclusion of a study comparing women whose partners wear condoms with those whose partners don't.
The study showed that the women who were directly exposed to semen were less depressed. The researchers think this is because mood-altering hormones in semen are absorbed through the vagina. They say they have ruled out other explanations.
Oh, and it apparently helps reduce the risk of breast cancer. From here.
In a study of over 15,000 women suspected of having performed regular fellatio and swallowed the ejaculatory fluid, over the past ten years, the researchers found that those actually having performed the act regularly, one to two times a week, had a lower occurrence of breast cancer than those who had not. There was no increased risk, however, for those who did not regularly perform.
Now all guys are hereby armed with the info they really need.
NeuroDoc: Thank you for recognising the fact that I was being utterly facetious in that last post.
I have read a bit (not nearly as much as I should have - mea culpa) about the student loan debacle; as such, I'll avoid commenting substantively on those particular situations.
We were steered towards one - and only one - "preferred lender." Apparently, it is not easy to get loans via other means, but is possible.
As for what I would do about it if there were a problem with the law school improperly using its position - eh, not sure. No harm, no foul, at least for me. IMHO, the better solution is the non-legal one: more and better education for incoming borrowers. Entrance counseling is almost non-existent; exit counseling, however, is more extensive. Doesn't seem to do much good, though, as you've already borrowed the money.
The one thing that really bothers the *(&^^ out of me is the "save on spending!" campaign that Access Group is running, and the little loan counseling sessions they hold in law school, as if loan payments will be substantially influenced by too many caramel macchiatos. When tuition alone costs $35,000/year, and we're the least expensive top 25 private (and our tuition ties that of UVA in-state), it's really hard to see how a few hundred a year will make any difference in your ability to repay your loans. At many schools, students are approaching $200,000 in loan debt, if they borrow for tuition, books, room, board, and health insurance.
neurodoc: It seems that no one is taking this terribly seriously, which I think is right given what appears to be relatively weak evidence.
Because the original post concerned the brain and I am a neurologist, albeit not a trailblazing researcher, I did think to comment on the report of a health-promoting effect of caffeine. What I said about that report might apply with still greater force to the information that knowledgelover has called to our attention. (Couldn't get the second link to work. Did expect to find the first report appeared in Hustler or some equally prominent scientific journal, but turn out to be nothing so impressive as an authority.)
BTW, how in the course of this thread did we get from the brain on to the gastrointestinal tract, and now from the gastrointestinal tract to the genitals, both male and female? (Respiratory if we include my passing mention of aspiration, and skin.)
Be careful about what doctors tell you. About five years ago, I began getting exercise induced heartburn. My cardiologist wanted to do an angiogram. I told him I had GERD and asked if exercise could cause reflux. He said "no," but I didn't believe him. Then I asked my GI, and he said "yes." He said he studied under the world's expert on exercised induced reflux, who performed many lab studies some of which included the how reflux varied with different sexual positions. Exercise can cause reflux. Over the next several years I consulted with two cardiologists who did imaging stress tests and ultrasound, and everything was negative. One doctor even told me that an angiogram for someone in my circumstance would have been malpractice. This is not the first time I've overruled a doctor to my ultimate benefit.
I asked several doctors how you tell the difference between heartburn and a coronary. They said that many times you really can't. Now how's that for something to worry about?
Speaking of worrying, I think stress is one important trigger for GERD symptoms. I rarely get stressed because I don't let much bother me. On those rare occasions when I do I notice the heartburn come back.
If stress is a trigger for GERD, and stress is managed (at least in my world) exlusively through eating lots of chocolate and getting a lot of exercise, both of which trigger GERD... how is one to avoid it?
theobromophile, our "conversations" are never boring. I just meant the student loan thing as a tease, because you had mention it once before.
As the parent of a daughter who took out a loan to pay for law school tuition, I have some personal interest in the subject. But the money my daughter borrowed (2003-2006) was at 3% I believe, which I saw as a great deal. (I don't know why the money was so cheap. I only wanted to assure myself that this deal that seem to be too good to be true was in fact true, that is that there were no catches to it. And there weren't.) The return on that "investment" has been very good so far, and I expect it will continue to be very good for years to come.
I do have a personal grouse about student loans, though a much lesser one than you. Mine is that I don't see why employers, especially the federal government, should pay off student loans for employees. It is one thing for the employer to pay for tuition and related expenses as an employee benefit, one that may redound to the employer's benefit too, in the course of the employee's employment. Why should they pay for educational expenses incurred before the employee signs on with them, though? Why should one new hire whose parents paid out of their own pockets the prodigious sums required for college, and perhaps graduate school, be paid x in salary, while another who borrowed to pay tuition and expenses or whose parents did receives x in salary + y in additional compensation in the form of loan repayment for them?
It seems to me a very different story when Harvard Law School decides to forgive senior year tuition for those students who take public interest law for 5 years after graduation. Something (tuition reduction) is being given in return for something (much reduced future earnings), and it is not unfair to anyone. Why should two equal new hires get very unequal compensation for the work they do, the difference dependent on how much they took out in student loans?
How righteous do I feel about this - well, if my daughter's firm had offered to pay off her loan as well as compensate her otherwise in the same amount as her similarly situated peers, I would have just shaken my head in amazement at the stupid, but good fortune (3% loan plus subsequent forgiveness of principle?!), and told her to accept graciously. (Do any law firms pay off the student loans of newly hired associates?)
Now, watch Andrew Cuomo over the next couple of years and see if he doesn't ride the student loan story and other hot button consumer issues to become the second Cuomo to serve as governor of NY.
And as for caffeine and rabbit brains...Did Reagan not drink enough coffee?
"If stress is a trigger for GERD, and stress is managed (at least in my world) exlusively through eating lots of chocolate and getting a lot of exercise, both of which trigger GERD... how is one to avoid it?"
None of these triggers apply to everyone all the time. Your exercise could calm you down without causing reflux thereby preventing stress induced symptoms. On the other hand, you might just be screwed. Try calming down with meditation.
Meanwhile all this discussion of GERD has brought back my symptoms. I'm not kidding.
There are procedures to remedy incompetent lower esophageal sphincters in adults with GERD, but according to my gastroenterologist, most fail within a few years, so no good answer in them.
Not knowing chocolate from shinola about medicine, physiology or GERD, but knowing intergalactic thread drift when I see it, I have a stoopid question.
Pacemakers to stimulate the nerves that control heartbeat are a commonplace now. What about some kind of pacemaker-like stimulator for the nerves that control the lower esophageal sphincter, to keep it contracted when it should be?
Or is the incompetence due to something besides the muscle not getting a signal to contract?
Or is the incompetence due to something besides the muscle not getting a signal to contract?
Again, well outside any expertise I have, but what the hell...
The sphincter's response to certain foodstuffs, e.g., chocolate, is probably somehow neurally mediated. But people with competent sphincters don't get reflux. It is those of use with incompetent sphincters, ones that don't close completely that have the symptoms, especially in the face of those provocations. It's an anatomic thing. You know our anatomy changes over time, some parts sagging more notably than others? And some are more affected by the sagging or loosening up than others. If weight is a contributor, then losing weight, which increases the pressure on the stomach and promotes reflux through an incompetent sphincter/valve, may help. (A mechanical fix or help, if you will.)
Could the LSE of people with GERD be flogged to perform better by electrical stimulation? I don't know. Maybe it happens with vagal nerve stimulators which are used for control of some refractory epilepsies, but I doubt anyone has paid any attention to what the LSE is doing, the focus being on seizure control, not reduction of reflux.
Be grateful for PPIs, and be as virtuous as A Zarkov is with regard to diet, which I am not. And if someday there is a complete, simple, safe fix for reflux, well that wonderful. In the meantime, be cautious about currently available procedures to fix it.
theobromophile, if you don't have GERD, why are spending any time on the "what if"? ("I sincerely hope that, by the time I would get GERD...") You should be thinking about how lovely it must be at this time of year around Lexington, passing the Bar exam, job prospects, enjoyment of chocolate without any unpleasant after effects, etc. The problems of ageing will come with time.
When you say that exercise causes reflux, do you mean that regular exercising can lead to the disease? Or do you mean that, once you have the disease, exercise can trigger an attack? The two are very different, and I'm not sure which you mean.
I've had pretty bad reflux for several years. I got rid of it almost immediately a while back when I went on the Atkins diet. No carbs, no reflux -- at least for me. It came back when I went off the diet. No real surprise there. It was getting worse and worse. About a month ago I started regularly doing yoga classes. I don't know what has done it, but the reflux is basically gone. I'm not dieting, not doing anything else out of the ordinary, so I think it must be the Yoga.
Dark chocolate is the worst for GERD supposedly. In regards to exercise what I have been reading says to that certain exercise makes GERD worse. Specifically where you do things that tighten the abdominal area. It said things like stationary bikes were what you wanted to do instead of things like weights. Losing some weight, even a little, is supposed to help a lot.
Dang! I was hoping to get them all out of the way early, so I could grow old more comfortably.
Thanks for your "non-expert" gloss on anti-GERD electro-flogging. I guarantee you that my med inexpertise exceeds yours by many orders of magnitude in any metric.
Well, hopefully this will never happen to me, or will be a moot point, because meditation stresses me out. I tried yoga once and only once. Horrible experience. If you've seen "Kissing Jessica Stein," you can picture what I'm talking about. Just not the meditating type. :)
Why should they pay for educational expenses incurred before the employee signs on with them, though? Why should one new hire whose parents paid out of their own pockets the prodigious sums required for college, and perhaps graduate school, be paid x in salary, while another who borrowed to pay tuition and expenses or whose parents did receives x in salary + y in additional compensation in the form of loan repayment for them?
There are several cheap answers:
1. If I found a firm (a firm, not The Firm)to pay off my loans, I would be happy.
2. It's the magnitude of the disparity, not the disparity itself, that is the issue. People without families routinely receive less compensation than those whose families are also covered under the employee health care plan, but few people get their panties (or other, YMMV) into a twist about that. It's the magnitude of the disparity.
3. Larger loans may indicate a more prestigious school (either private v. public, or one that does not need to offer merit aid to get talented students), so the firm would like to recognise the supposedly superiour education.
4. For public-service jobs, it may be the only way in which such a career is affordable.
5. Such programmes ensure that the take-home salary of all of the new hires is the same, regardless of whether or not they came from wealthy families.
The latter, in limited circumstances, is, IMHO, the only decent explanation. Now, unless I had moved to a state with low in-state tuition and established residency before applying to law school, my choices for legal education were: really expensive and really freaking expensive. (UConn would have been the cheapest option. First year students from MA can get the "New England reciprocity" tuition, as MA does not have a law school, which is in-state + 50%. 2Ls and 3Ls are eligible for in-state tuition if they switch their residency. Unlike, say, VA and MI, such residency for the purposes of education is sufficient. I think the total bill would have been aboutb $80,000, maybe $90,000.)
My friends who got out of law school in '05 have student loans that are consolidated around 3%. Some of them stretch them out over a long, long period of time because they'll make more money later in life or can do better in a high-yield savings account.
You should be thinking about how lovely it must be at this time of year around Lexington, passing the Bar exam, job prospects, enjoyment of chocolate without any unpleasant after effects, etc.
Hey, the prospect of life without chocolate (which I'm actually eating right now) is a little rough. Expect a day or two of mental "aagghhhhhh".
I think you're in D.C., so your weather is a more humid version of ours. It's been a cold spring, hasn't it?
Mostly, I'm dreaming about this upcoming summer - perhaps researching with a prof for a while, then up to MA - hang out with my siblings, my parents, and the dog, head on down to Cape Cod for kayaking, swimming, trips to the Vineyard - and, supposedly, amongst the kayaking, swimming, etc. will study enough to pass the bar.
Lex is very beautiful. While I don't like small towns, and will be happy to move someplace that is closer to civilisation, I'm beginning to get a bit nostaligic. Three (four?) years later, and it'll be time to leave. Strange, in some ways.
"When you say that exercise causes reflux, do you mean that regular exercising can lead to the disease? Or do you mean that, once you have the disease, exercise can trigger an attack?"
A good question. The conversation with my docs was in the context of my GERD. The rowing machine would trigger heartburn, which got relieved when I switched to a treadmill. Although I can get it if I hit the treadmill hard enough. I don't know the context of the research, but I suspect that people without GERD don't get exercise-induced reflux.
Hey neurodoc, the second link re seminal phagia via fellatio and breast cancer works fine for me, but in case you can't get it to work, below you'll find the text of the article (which is actually a hoax made to appear as if it came from CNN and the AP - see an article about the hoax.) It's a hoax, but if you print it out it might be good enough to convince your significant other . . .
Although that is a hoax, there is another study indicating that swallowing may reduce preeclampsia. Then again, correlation does not equal causation, right? (But who wants to bring that up when you want some from your wife?).
As for how this subject came up? Just refer to the comment by lostmycookies (which I quoted). Ultimately, I guess all of this digression started from the very first poster who mused that his beer and rare steak diet might be healthful, which traversed into all things related to the GI tract and beyond:
Study: Fellatio may significantly decrease the risk of breast cancer in women
(AP) -- Women who perform the act of fellatio and swallow semen on a regular basis, one to two times a week, may reduce their risk of breast cancer by up to 40 percent, a North Carolina State University study found.
Doctors had never suspected a link between the act of fellatio and breast cancer, but new research being performed at North Carolina State University is starting to suggest that there could be an important link between the two.
In a study of over 15,000 women suspected of having performed regular fellatio and swallowed the ejaculatory fluid, over the past ten years, the researchers found that those actually having performed the act regularly, one to two times a week, had a lower occurrence of breast cancer than those who had not. There was no increased risk, however, for those who did not regularly perform.
"I think it removes the last shade of doubt that fellatio is actually a healthy act," said Dr. A.J. Kramer of Johns Hopkins School of Medicine, who was not involved in the research. "I am surprised by these findings, but am also excited that the researchers may have discovered a relatively easy way to lower the occurrence of breast cancer in women."
The University researchers stressed that, though breast cancer is relatively uncommon, any steps taken to reduce the risk would be a wise decision.
"Only with regular occurrence will your chances be reduced, so I encourage all women out there to make fellatio an important part of their daily routine," said Dr. Helena Shifteer, one of the researchers at the University. "Since the emergence of the research, I try to fellate at least once every other night to reduce my chances."
The study is reported in Friday's Journal of Medical Research.
In 1991, 43,582 women died of breast cancer, as reported by the National Cancer Institute.
Dr. Len Lictepeen, deputy chief medical officer for the American Cancer Society, said women should not overlook or "play down" these findings.
"This will hopefully change women's practice and patterns, resulting in a severe drop in the future number of cases," Lictepeen said.
Sooner said the research shows no increase in the risk of breast cancer in those who are, for whatever reason, not able to fellate regularly.
"There's definitely fertile ground for more research. Many have stepped forward to volunteer for related research now in the planning stages," he said.
Almost every woman is, at some point, going to perform the act of fellatio, but it is the frequency at which this event occurs that makes the difference, say researchers. Also key seems to be the protein and enzyme count in the semen, but researchers are again waiting for more test data.
The reasearch consisted of two groups, 6,246 women ages 25 to 45 who had performed fellatio and swallowed on a regular basis over the past five to ten years, and 9,728 women who had not or did not swallow. The group of women who had performed and swallowed had a breast cancer rate of 1.9 percent and the group who had not had a breast cancer rate of 10.4 percent.
"The findings do suggest that there are other causes for breast cancer besides the absence of regular fellatio," Shafteer said. "It's a cause, not THE cause."
NeuroDoc: in light of your discussion about forgiveness of law school loans, what do you think about this?
Here in Massachusetts, legislative leaders have proposed bills to forgive medical school debt for those willing to practice primary care in underserved areas; a similar law, worth $15.6 million, passed in New York this week.
theobromophile, the MA proposal, like the HLS tuition waiver, is easy to justify and defend IMO. Neither looks to whether parents or students paid from their own funds, however easy or hard that may have been for them to do, or whether instead they took on debt. And while HLS is in effect doing it "prospectively," forgiving the last year's tuition for those who commit themselves to public service law and the low compensation that brings, and MA would be doing it, paying off medical school debt (not "forgiving" it unless the money was owed directly to MA) for those commiting to practice primary care in underserved areas and what will probably be lesser compensation, there is no significant difference in that both are intended to help what amount to third party beneficiaries. (HLS has no financial or other enforceable responsibility to those who might benefit from its students who would go into public service law. MA might find it more expensive to fulfill its obligations if it did not encourage more new medical school grads to practice primary care in underserved parts of the state.) Can you think of any arguments I might make against the MA proposal, especially "fairness" ones?
As for your answers 1-5 (actually 2-5), I don't see any of them as persuasive:
#2 - employers don't vary the amount they contribute toward the purchase of health benefits according to the amount earned by the employee or the employee's net worth. And unless they are self-insuring, employers are probably paying a premium based on the number of families insured rather than the number of people in those families. Hard to see much, if any, likeness between this one and an employer (most often a government one, I think) paying out much more (salary + debt repayment) for an employee who incurred school debt and one who didn't (or one whose parents incurred the debt!).
#3 - amount of student debt as an indicator of the alma mater's prestige??? If there is a positive correlation in that one, it must be extremely weak. And why would a firm use an indirect and dubious indicator when they could base pay on the true answer, the US News and World Report rankings?
#4 - wouldn't both debt-burdened and those not burdened by debt (though their parents may be) be equally encouraged to take public sector or jobs with non-profits by the promise of greater compensation? I think it may work because people nod their heads in agreement believing it to somehow be "right," but I don't think it holds up to logical scrutiny.
#5 - equalizing take home pay. The smart thing for anyone aspiring to work for the government or another employer that will pay off student debt would be to take on all the student debt they could, wouldn't it? By doing so, they could look forward to "equal" take home pay, at the same time they would wind up substantially better compensated than those who had not taken on any debt. (Does the IRS tax as "income" this sort of debt forgiveness or pay down as it does under other circumstances?
As Martha Stewart would say, "A long-term loan at 3% is a good thing, from the borrower's perspective."
Lexington and environs: my experience of it is limited to a couple of visits in the fall, when it was really lovely.
civilisation and programmes? Did you grow up in another part of the world, one farther away than MA, perhaps across an ocean from here?
stressed out by meditation?? Don't do it myself, but that does sound worrisome. Type A+++, maybe. Funny that that which stresses out most 3Ls, passing the Bar, doesn't seem to be a concern of yours. And you're waiting anticipatorily for GERD?! You do need that summer break.
NeuroDoc, I believe I said (or thought I did) that those justifications didn't hold water. I can see why someone who does not much think it through would propose loan forgiveness for those in the private sector or the government, but I do agree with you. You asked. I tried to answer. :p
Isn't it cherry blossom season up in DC? When is peak time for that?
Trees are blooming here. Very pretty. I would send you a picture, but a) it did not come out well, as the sky is quite grey; b) I don't know how to upload pictures from my cell onto the internet; and c) I have no way of getting it to you. So I'll just have to say: take my word for it, Lexington is lovely in the spring (and moreso when it's actually warm and sunny out, not this cold wet spring we've been experiencing*).
Have you ever done the Skyline Drive? (The Waynesboro exit/entrance is about 40 minutes away from here.) Really lovely way to see the Shenandoah.
Bar exam: see, I still have to take the patent bar, too. Something else to worry about. Maybe I just have visions of sitting on the deck, looking at the water, and, instead of drinking pina coladas and doing the crossword puzzle with my dad, drinking pina coladas and studying for the bar. At least that's how I envision this summer happening.
As for being stressed by meditation: yeah, well, some of us are a little Type A. Some of us also need to be moving around. Last time I checked, there is no "meditative rush," but there is a runner's high. (The NYT had an article about it a few weeks ago, but it included some nonsense about how you need to run for 10 miles before that happens. Try two or three.) Then again, you're the neuro guy, so perhaps I ought to defer to you on that. :)
Last time I checked, there is no "meditative rush," but there is a runner's high. (The NYT had an article about it a few weeks ago, but it included some nonsense about how you need to run for 10 miles before that happens. Try two or three.) Then again, you're the neuro guy, so perhaps I ought to defer to you on that.
No, I can't tell you anything about this. But my daughter's boyfriend could. He has run a 2 hour 36 minute marathon.
Bar exam: see, I still have to take the patent bar, too. Something else to worry about.
The patent bar is the easiest exam you'll ever take as a patent attorney -- all the answers are right on the page and they're all in the MPEP. I recommend the John White/PLI class, for focused presentation of the material. Then practice the old exam questions until they start to look familiar to you.
The patent bar is the easiest exam you'll ever take as a patent attorney -- all the answers are right on the page and they're all in the MPEP.
Um, with a pass rate of something like 47%, I don't think that it can be called "easy." I mean, I have a serious love on for multiple-choice tests, but that pass rate (inclusive of tons of nerdy engineers, no less) freaks me out.
Neurodoc: That's an amazing time. (Really, it is. 1.6% overall, and, among men, probably about 2.7%. That includes up to three hours, though, so I suspect that the actual percentile is lower. You knew that, though!) Even at my best shape (years ago, before I completely wrecked my ankle), I could do 15 miles in two hours.
Does the boyfriend drink ridiculous amounts of espresso beforehand? (Look! Look! We're back on topic!)
Nothing to do with caffeine, perhaps but on the health and nutrition topic and related to Alzheimer's Disease, in his book Good Calories, Bad Calories, Gary Taubes makes the case that the "type" of calories we eat is more important than the number of them. Pretty interesting and to me, fairly convincing. It is certainly not politically correct to assert that "dietary fat, whether saturated or not, does not cause heart disease."
Hopefully someone will publish a study soon affirming that my beer and rare steak diet is the key to a long life.
Mmmmmm... case of beeer.
Given that coffee protects the liver from cirrhosis, I'm not surprised to hear that, like alcohol and chocolate, it is another wonder-food.
(For those wondering: yes, I do consider my chocolate-red wine-coffee-fruit diet to be very, very healthy.)
Thanks, Orin!
Nobody likes a wet blanket.
I hope you save this comment up and write it again, right after just about every pop-press dietary health article ever written comes out.
Just to be on the safe side, I think I'll invest in a cappaccino machine. After all, lawyers have to take care of their brains like prostitutes have to care for their bodies - tools of the trade, etc.
Dr. Aragon: "Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties."
Dr. Melik: "You mean there was no deep fat? No steak or cream pies or... hot fudge?"
Dr. Aragon: "Those were thought to be unhealthy... precisely the opposite of what we now know to be true."
Dr. Melik: "Incredible!"
All things I had to give up because of GERD, dangit!
{cappucino gigolo}
SenatorX, to start with, I presume that you taking a PPI (proton pump inhibitor drug, e.g., Nexium, Pepcid, etc.), and that you are taking it correctly. (I thought once-a-day meant that I could take it nightly at bedtime, until my gastroenterologist told me that that was exactly the wrong way to go about it. Best to take it in AM after an overnight fast, then follow with some protein intake.) If you aren't, then you are denying yourself the relief that a PPI can give.
Next, "chocolate" to be sure, highly effective in bringing on reflux. And "red wine" works for (against) me too, but I think it is alcohol in general rather than just red wine. I can't say anything about coffee or cafeine from person experience, because I rarely drink it. "Fruits" puzzles me, so would you say which ones in particular may have caused you problems. (I expect there is a fair amount of variation from individual to individual in what provokes their symptoms, though some things may be common to all, e.g., chocolate.) Almonds is another of the things I should avoid at night.
But SenatorX, do you have much of a problem during the course of the day, or like me, do you have your problem principally at night, maybe an hour or two after you fall asleep? (I wonder about some connection between sphincter tone and the stage of sleep, but I don't think the necessary study to establish or rule that out has been done.) If it is a nighttime thing, can't you have those things provided you don't have them within hours of retiring. (And provided you don't eat alot before retiring too, since I think large intake no matter the composition is another thing to avoided in order to avoid the nasty symptoms.) I won't suggest shock blocks under the bed, or even sleeping with many pillows, because I think that of minimal benefit for most people.
Finally, have you been endoscoped from the north (gastroscopy) as well as the south (colonoscopy), the latter if you are more than 50 years old? GERD is usually just a terrible, unpleasant nuisance, unless it leads to aspiration pneumonia, but in susceptible individuals it can put them at heightened risk for cancer of the esophagus.
I suppose that the drug companies are happy to make the many billions of $s that they make with PPIs and consider that to be the pharmacologic agent. I wish, however, they would look for something(s) that would block whatever it is in those foodstuffs and drinks that aggravates the GERD by causing further sphincter relaxation, and hence incompetence. (It must be more than one component, however, since I don't think alcohol and chocolate have anything in common, other than the pleasure they can give.)
Fixed that for you.
I will begin providing coffee to my rabbit at once.
My own brain is being kept quite safe by bourbon. A bit muddled, but safe.
Well you, of all people, would say so.
I eat my daily chocolate every night before bed, just to be safe.
I also have GERD (doesn't everyone?). This is the first that I've heard one should take the pill in the morning. PPI seems to work for me taking it anytime.
I've found that my GERD condition is extremely sensitive to weight. Even a gain of 4 lbs significantly increases symptoms. I can bring the symptoms down to the point where only occasional use of Zantac is needed by losing enough weight.
Everything gets better when you lose weight. BTW I was not overweight to begin with. Of course "overweight" is defined as a BMI >25. That's wrong. It's really BMI >21. Twenty five was a political compromise.
I wonder if anyone can confirm or deny my impression that GERD is an American disease, caused by our lifestyle or eating habits. One sufferer I know developed it in her early 20s, and does sleep in a bed whose head end is elevated several inches.
Dairy is supposed to promote weight loss, and, of course, prevent osteoperosis (sp?). Ergo, my lunch (chocolate frappe) is obviously a health food, one which will prevent the onset of GERD. Right?
In case anyone was wondering - blood pressure is about 90/60, cholesterol is something like 135, etc., so I'm obviously doing something right.
Oh? thats not how correlation works? Sorry!
I expect you knew most of that, but I thought to serve it up in faux-medical terms.
Actually, neurodoc, I'm waiting for a federal bailout for students who made unwise borrowing decisions, gave no proof of income, and expected the market to keep improving.
Wait, that only happens to homeowners? Drat.
A. Zarkov, I expect that some weight loss might help me with the GERD, and perhaps the obstructive sleep apnea too. And it remains my intention to try it one of these days. Interesting that you say so little change in your weight can have notable effects on the GERD symptoms. Are some things, e.g., chocolate, or habits, e.g., eating a lot within a couple of hours of retiring, especially provocative of symptoms for you? Have you ever been gastroscoped? (GERD seems so banal a disorder, but it can cause changes to the distal esophagus that set up those who have it for cancer.)
The PPIs do a good job of what they are supposed to do, which is block acid production and cut down the volume of stomach secretions. I appreciate the fact that we can turn to them. But cutting off acid production doesn't mean that stomach contents can't reflux up the esophagus when the lower esophageal sphincter isn't working up to snuff to prevent that back flow. (I expect GERD sufferers know all this from their own experiences.) Being disciplined with respect to one's habits can make a big difference, but easier said than done for some of us.
I'm pretty sure it's the gatekeeper in Macbeth who says that alcohol "increaseth the desire but taketh away the performance." All off memory, so disclaimers apply.
Macbeth, Act 2, Scene 3:
...
MACDUFF:
What three things does drink especially provoke?
PORTER:
Marry, sir, nose-painting, sleep, and
urine. Lechery, sir, it provokes, and unprovokes;
it provokes the desire, but it takes
away the performance: therefore, much drink
may be said to be an equivocator with lechery:
it makes him, and it mars him; it sets
him on, and it takes him off; it persuades him,
and disheartens him; makes him stand to, and
not stand to; in conclusion, equivocates him
in a sleep, and, giving him the lie, leaves him.
Funny I also have sleep apnea, and yes weight loss helps that too. Yes I have been gastroscoped, twice in about 10 years. I asked my doc if even a small weight loss can have a noticeable effect and he said, “yes” without hesitation. Managing what and when I eat does control symptoms as well as using Gaviscon once in a while. I suspect that if I can lose another 15-20 pounds the GERD will improve significantly and that will put my BMI at about 22. Weight loss can be done if you log your total caloric intake and get a lot of aerobic exercise. Weight training also helps increase muscle mass, which can reset your metabolism. I use an EatSmart food scale, which has a built-in database of calories. You punch in codes and then just put food on your plate until you hit the desired calorie level. Without an objective measure of how much you’re eating it’s very easy to fool yourself.
I am taking Nexium in the morning when i wake up and waiting 1 hour to eat and lately I have had to be very restrictive on what I eat or it triggers it again. Before I realized what was wrong with me it had gotten very bad actually and it really is amazing the kinds of pains and issues GERD can cause. I was pretty sure I had gallstones or cancer for a while as the pain in my abdomen, side, and back was also combined with odd lumps I would find on my stomach. The lumps however go away within a day and my umpteen blood tests all are good. The doctors have no idea about this symptom and really it took 4 months, x-ray, ct, sonogram, and MRI before they referred me to a gastro. All the tests found nothing wrong while I am laying there in massive discomfort day after day.
I think I am getting control of it but I probably will request some GI scope just to be sure because it still is bothering me with weird pain in my side that moves around. What makes it worse for me is I also have a chronic kidney stone problem (passed something like 12 stones so far) so I am on a low/no oxalate diet too. That complicated the diagnosis for GERD as they all kept pushing it was kidney stones even though I kept telling them that it feels completely different.
Right now all I have is room temperature water all day long, nexium, a bagel in the morning, some humus and whole wheat pita for lunch, and a small piece of bland meat with some veggies for dinner. This works though and is better than being in pain all the time and feeling like you are going to die soon. I also started working out again and an added benefit is the weight loss. I definitely think weight has something to do with it but the food types even more so. I was drinking lots of coffee for a while (5-6 cups a day) and I also discovered tomato sauce of any form (which I love) is a major killer. Hard candies are good though for saliva generation helps and I just started adding fish into my diet again which seems ok.
GERD has a silly sounding name and it seems like a common problem but it really can cause serious quality of life problems if you have it.
Infants can have this, and it may look like seizures, because they suddenly stiffen, extending (retroflexing) their back and neck in response to the terrible burning sensation when stomach acid goes where it is not supposed to go, that is back up the esphogus, irritating the sensitive lining there (Sandifur's syndrome). Children with neurodevelopmental delay who can't be fed by mouth because they may aspirate what they are being given into their lungs, which is decidedly not good, get operated open
to allow feedings directly into the stomach by way of a tube (PEG), and with that the upper portion of the stomach is closed off to prevent the feedings from going back up the esophagus (fundal plication). There are procedures to remedy incompetent lower esophageal sphincters in adults with GERD, but according to my gastroenterologist, most fail within a few years, so no good answer in them.
I don't recall ever experiencing any GERD symptoms before one day a few years ago. We were in Padstow, England and ate at Rick Stein's excellent fish restaurant there. I had an appetizer of curried Spanish mackeral, and hours later, I had this most incredible, painful burning in my throat. Absolute misery, not something that could be ignored. When we got home and I went to see my GI doctor, I wanted to give him all the details of what I had eaten, the onset of symptoms, the subjective perceptions, etc., but he had no time or interest in all that and just pronounced the diagnosis of GERD with absolute confidence that this explained it, as it did. (When it is one's own affliction rather than someone else's, the details seem hugely important, while for my doctor GERD said it all.) I don't know how significant, if at all significant it was that I had had that spicey food. Spicey foods, when I eat them on infrequent occasions, don't cause me obvious problems, though they may do so for others, like the lady eating in the Italian restaurant featured in one of the Nexium ads. Chocolate is the most certain of provocations for me, so that a relatively small amount of it within a few hours of lying down to sleep almosts guarantees that I will be awakened by reflux.
Thankfully, I don't have Barrett's esophagus, those changes to the cells lining the esophagus that may set one up for cancer. That makes a fairly banal problem in to a definitely not banal one, poising a hanging sword over one's head, leaving them to wonder if it will one day drop. (I keep asking myself why I have this banal disorder, why my lower esophageal sphincter won't do the simple job assigned it, that is blocking backflow from the stomach. Then a voice inside my head asks me whether I would rather have a big league non-banal disease, one that would be much more "interesting" to colleagues than the stupid GERD that I have. The answer that comes immediately is "NO.")
I have no idea why people vary as to what provokes GERD symptoms in them, but it seems that they do vary in that regard. So, I can look at lists of what can bring on reflux and see that only a few cause me any problem. (Why couldn't it be just things I don't particularly care for that cause me this problem?!)
SenatorX, the Nexium should knock out the stomach acid production, though you might need another one at night to hold you. But knocking out stomach acid only means when your stomach contents reflux, you won't suffer the terrible burning; it doesn't mean that partially digested food won't come back up and cause you coughing and choking. I think that those things you find cause you acute symptoms are things that cause the sphincter to relax and allow reflux, rather than elicit acid production. But I won't speculate whether or not all that you report does relate to GERD.
Interesting that you mention hard candies and saliva production. At a party given by a fellow neurologist celebrating his elevation to a full professorship at a prestigious school, I encounter a gastroenterologist. Seeing this as an opportunity to learn something, I started telling him how my symptoms never came on soon after I fell asleep, nor very long after, but rather almost always about two hours later, leading me to believe that it must have something to do with the stage of sleep I was in, my theory being that the esophageal sphincter was just doing something physiologic in response to what was going on in the brain at that point. The GI guy, who had been asking the neurologists present about his father's unfortunate neurologic illness, told me it wasn't directly related to sleep, or not related to sleep in the way I had imagined. According to him, saliva production slows down or stops during sleep. Saliva has the pH of a base, so buffers acids. Thus, when we first fall asleep and for awhile afterwards, acid coming back up from the stomach gets neutralized by the saliva we swallow. But we stop making saliva, so after awhile it isn't there to neutralize the acid that is refluxing, and it is then that the burning comes on and we wake up with it. I'm not persuaded that it has nothing to do with stage of sleep per se, but the GI person is undoubtedly much better informed about these things, and his explanation is straightforward and entirely plausible.
So now, GERD sufferors arise, throw off your chains, and demand that the government do something about this!
School financial offices must owe something of a fiduciary duty to those students who turn to them for help. Were yours on the up and up with you? Andrew Cuomo, who succeeded Eliot Spitzer (yeah, him again) as NY's AG, and is now eyeing Spitzer's last job as NY's governor, has targeted student lenders (and others) in the manner that Spitzer went after Wall Street. Through his efforts, we now know about shenanigans where student loans have been concerned, with those responsible for counseling students being paid off by the big lenders. Hopkins, for example, fired the lady in charge of their financial aid office when they learned that she had received emoluments from lenders, perhaps to the detriment of student borrowers. So perhaps now, with your now keener legal eye, you should look into whether or not you got the loans you should have gotten. To do so wouldn't cause you any libertarian non-GERD heartburn, would it? (Or is "caveat emptor" combined with "laissez-faire" the libertarian's fundamental creed?)
Actually, some good news for your wife (and hopefully you by extension). Semen does help balance hormones.
From this report.
Oh, and it apparently helps reduce the risk of breast cancer. From here.
Now all guys are hereby armed with the info they really need.
I have read a bit (not nearly as much as I should have - mea culpa) about the student loan debacle; as such, I'll avoid commenting substantively on those particular situations.
We were steered towards one - and only one - "preferred lender." Apparently, it is not easy to get loans via other means, but is possible.
As for what I would do about it if there were a problem with the law school improperly using its position - eh, not sure. No harm, no foul, at least for me. IMHO, the better solution is the non-legal one: more and better education for incoming borrowers. Entrance counseling is almost non-existent; exit counseling, however, is more extensive. Doesn't seem to do much good, though, as you've already borrowed the money.
The one thing that really bothers the *(&^^ out of me is the "save on spending!" campaign that Access Group is running, and the little loan counseling sessions they hold in law school, as if loan payments will be substantially influenced by too many caramel macchiatos. When tuition alone costs $35,000/year, and we're the least expensive top 25 private (and our tuition ties that of UVA in-state), it's really hard to see how a few hundred a year will make any difference in your ability to repay your loans. At many schools, students are approaching $200,000 in loan debt, if they borrow for tuition, books, room, board, and health insurance.
BTW, how in the course of this thread did we get from the brain on to the gastrointestinal tract, and now from the gastrointestinal tract to the genitals, both male and female? (Respiratory if we include my passing mention of aspiration, and skin.)
Be careful about what doctors tell you. About five years ago, I began getting exercise induced heartburn. My cardiologist wanted to do an angiogram. I told him I had GERD and asked if exercise could cause reflux. He said "no," but I didn't believe him. Then I asked my GI, and he said "yes." He said he studied under the world's expert on exercised induced reflux, who performed many lab studies some of which included the how reflux varied with different sexual positions. Exercise can cause reflux. Over the next several years I consulted with two cardiologists who did imaging stress tests and ultrasound, and everything was negative. One doctor even told me that an angiogram for someone in my circumstance would have been malpractice. This is not the first time I've overruled a doctor to my ultimate benefit.
I asked several doctors how you tell the difference between heartburn and a coronary. They said that many times you really can't. Now how's that for something to worry about?
Speaking of worrying, I think stress is one important trigger for GERD symptoms. I rarely get stressed because I don't let much bother me. On those rare occasions when I do I notice the heartburn come back.
If stress is a trigger for GERD, and stress is managed (at least in my world) exlusively through eating lots of chocolate and getting a lot of exercise, both of which trigger GERD... how is one to avoid it?
I ask this somewhat seriously, actually.
As the parent of a daughter who took out a loan to pay for law school tuition, I have some personal interest in the subject. But the money my daughter borrowed (2003-2006) was at 3% I believe, which I saw as a great deal. (I don't know why the money was so cheap. I only wanted to assure myself that this deal that seem to be too good to be true was in fact true, that is that there were no catches to it. And there weren't.) The return on that "investment" has been very good so far, and I expect it will continue to be very good for years to come.
I do have a personal grouse about student loans, though a much lesser one than you. Mine is that I don't see why employers, especially the federal government, should pay off student loans for employees. It is one thing for the employer to pay for tuition and related expenses as an employee benefit, one that may redound to the employer's benefit too, in the course of the employee's employment. Why should they pay for educational expenses incurred before the employee signs on with them, though? Why should one new hire whose parents paid out of their own pockets the prodigious sums required for college, and perhaps graduate school, be paid x in salary, while another who borrowed to pay tuition and expenses or whose parents did receives x in salary + y in additional compensation in the form of loan repayment for them?
It seems to me a very different story when Harvard Law School decides to forgive senior year tuition for those students who take public interest law for 5 years after graduation. Something (tuition reduction) is being given in return for something (much reduced future earnings), and it is not unfair to anyone. Why should two equal new hires get very unequal compensation for the work they do, the difference dependent on how much they took out in student loans?
How righteous do I feel about this - well, if my daughter's firm had offered to pay off her loan as well as compensate her otherwise in the same amount as her similarly situated peers, I would have just shaken my head in amazement at the stupid, but good fortune (3% loan plus subsequent forgiveness of principle?!), and told her to accept graciously. (Do any law firms pay off the student loans of newly hired associates?)
Now, watch Andrew Cuomo over the next couple of years and see if he doesn't ride the student loan story and other hot button consumer issues to become the second Cuomo to serve as governor of NY.
And as for caffeine and rabbit brains...Did Reagan not drink enough coffee?
None of these triggers apply to everyone all the time. Your exercise could calm you down without causing reflux thereby preventing stress induced symptoms. On the other hand, you might just be screwed. Try calming down with meditation.
Meanwhile all this discussion of GERD has brought back my symptoms. I'm not kidding.
Pacemakers to stimulate the nerves that control heartbeat are a commonplace now. What about some kind of pacemaker-like stimulator for the nerves that control the lower esophageal sphincter, to keep it contracted when it should be?
Or is the incompetence due to something besides the muscle not getting a signal to contract?
The sphincter's response to certain foodstuffs, e.g., chocolate, is probably somehow neurally mediated. But people with competent sphincters don't get reflux. It is those of use with incompetent sphincters, ones that don't close completely that have the symptoms, especially in the face of those provocations. It's an anatomic thing. You know our anatomy changes over time, some parts sagging more notably than others? And some are more affected by the sagging or loosening up than others. If weight is a contributor, then losing weight, which increases the pressure on the stomach and promotes reflux through an incompetent sphincter/valve, may help. (A mechanical fix or help, if you will.)
Could the LSE of people with GERD be flogged to perform better by electrical stimulation? I don't know. Maybe it happens with vagal nerve stimulators which are used for control of some refractory epilepsies, but I doubt anyone has paid any attention to what the LSE is doing, the focus being on seizure control, not reduction of reflux.
Be grateful for PPIs, and be as virtuous as A Zarkov is with regard to diet, which I am not. And if someday there is a complete, simple, safe fix for reflux, well that wonderful. In the meantime, be cautious about currently available procedures to fix it.
I've had pretty bad reflux for several years. I got rid of it almost immediately a while back when I went on the Atkins diet. No carbs, no reflux -- at least for me. It came back when I went off the diet. No real surprise there. It was getting worse and worse. About a month ago I started regularly doing yoga classes. I don't know what has done it, but the reflux is basically gone. I'm not dieting, not doing anything else out of the ordinary, so I think it must be the Yoga.
Thanks for your "non-expert" gloss on anti-GERD electro-flogging. I guarantee you that my med inexpertise exceeds yours by many orders of magnitude in any metric.
Well, hopefully this will never happen to me, or will be a moot point, because meditation stresses me out. I tried yoga once and only once. Horrible experience. If you've seen "Kissing Jessica Stein," you can picture what I'm talking about. Just not the meditating type. :)
There are several cheap answers:
1. If I found a firm (a firm, not The Firm)to pay off my loans, I would be happy.
2. It's the magnitude of the disparity, not the disparity itself, that is the issue. People without families routinely receive less compensation than those whose families are also covered under the employee health care plan, but few people get their panties (or other, YMMV) into a twist about that. It's the magnitude of the disparity.
3. Larger loans may indicate a more prestigious school (either private v. public, or one that does not need to offer merit aid to get talented students), so the firm would like to recognise the supposedly superiour education.
4. For public-service jobs, it may be the only way in which such a career is affordable.
5. Such programmes ensure that the take-home salary of all of the new hires is the same, regardless of whether or not they came from wealthy families.
The latter, in limited circumstances, is, IMHO, the only decent explanation. Now, unless I had moved to a state with low in-state tuition and established residency before applying to law school, my choices for legal education were: really expensive and really freaking expensive. (UConn would have been the cheapest option. First year students from MA can get the "New England reciprocity" tuition, as MA does not have a law school, which is in-state + 50%. 2Ls and 3Ls are eligible for in-state tuition if they switch their residency. Unlike, say, VA and MI, such residency for the purposes of education is sufficient. I think the total bill would have been aboutb $80,000, maybe $90,000.)
My friends who got out of law school in '05 have student loans that are consolidated around 3%. Some of them stretch them out over a long, long period of time because they'll make more money later in life or can do better in a high-yield savings account.
Hey, the prospect of life without chocolate (which I'm actually eating right now) is a little rough. Expect a day or two of mental "aagghhhhhh".
I think you're in D.C., so your weather is a more humid version of ours. It's been a cold spring, hasn't it?
Mostly, I'm dreaming about this upcoming summer - perhaps researching with a prof for a while, then up to MA - hang out with my siblings, my parents, and the dog, head on down to Cape Cod for kayaking, swimming, trips to the Vineyard - and, supposedly, amongst the kayaking, swimming, etc. will study enough to pass the bar.
Lex is very beautiful. While I don't like small towns, and will be happy to move someplace that is closer to civilisation, I'm beginning to get a bit nostaligic. Three (four?) years later, and it'll be time to leave. Strange, in some ways.
A good question. The conversation with my docs was in the context of my GERD. The rowing machine would trigger heartburn, which got relieved when I switched to a treadmill. Although I can get it if I hit the treadmill hard enough. I don't know the context of the research, but I suspect that people without GERD don't get exercise-induced reflux.
How about something purely meditative? Or the various relaxation exercises? You could also try biofeedback.
Although that is a hoax, there is another study indicating that swallowing may reduce preeclampsia. Then again, correlation does not equal causation, right? (But who wants to bring that up when you want some from your wife?).
As for how this subject came up? Just refer to the comment by lostmycookies (which I quoted). Ultimately, I guess all of this digression started from the very first poster who mused that his beer and rare steak diet might be healthful, which traversed into all things related to the GI tract and beyond:
Study: Fellatio may significantly decrease the risk of breast cancer in women
(AP) -- Women who perform the act of fellatio and swallow semen on a regular basis, one to two times a week, may reduce their risk of breast cancer by up to 40 percent, a North Carolina State University study found.
Doctors had never suspected a link between the act of fellatio and breast cancer, but new research being performed at North Carolina State University is starting to suggest that there could be an important link between the two.
In a study of over 15,000 women suspected of having performed regular fellatio and swallowed the ejaculatory fluid, over the past ten years, the researchers found that those actually having performed the act regularly, one to two times a week, had a lower occurrence of breast cancer than those who had not. There was no increased risk, however, for those who did not regularly perform.
"I think it removes the last shade of doubt that fellatio is actually a healthy act," said Dr. A.J. Kramer of Johns Hopkins School of Medicine, who was not involved in the research. "I am surprised by these findings, but am also excited that the researchers may have discovered a relatively easy way to lower the occurrence of breast cancer in women."
The University researchers stressed that, though breast cancer is relatively uncommon, any steps taken to reduce the risk would be a wise decision.
"Only with regular occurrence will your chances be reduced, so I encourage all women out there to make fellatio an important part of their daily routine," said Dr. Helena Shifteer, one of the researchers at the University. "Since the emergence of the research, I try to fellate at least once every other night to reduce my chances."
The study is reported in Friday's Journal of Medical Research.
In 1991, 43,582 women died of breast cancer, as reported by the National Cancer Institute.
Dr. Len Lictepeen, deputy chief medical officer for the American Cancer Society, said women should not overlook or "play down" these findings.
"This will hopefully change women's practice and patterns, resulting in a severe drop in the future number of cases," Lictepeen said.
Sooner said the research shows no increase in the risk of breast cancer in those who are, for whatever reason, not able to fellate regularly.
"There's definitely fertile ground for more research. Many have stepped forward to volunteer for related research now in the planning stages," he said.
Almost every woman is, at some point, going to perform the act of fellatio, but it is the frequency at which this event occurs that makes the difference, say researchers. Also key seems to be the protein and enzyme count in the semen, but researchers are again waiting for more test data.
The reasearch consisted of two groups, 6,246 women ages 25 to 45 who had performed fellatio and swallowed on a regular basis over the past five to ten years, and 9,728 women who had not or did not swallow. The group of women who had performed and swallowed had a breast cancer rate of 1.9 percent and the group who had not had a breast cancer rate of 10.4 percent.
"The findings do suggest that there are other causes for breast cancer besides the absence of regular fellatio," Shafteer said. "It's a cause, not THE cause."
As for your answers 1-5 (actually 2-5), I don't see any of them as persuasive:
#2 - employers don't vary the amount they contribute toward the purchase of health benefits according to the amount earned by the employee or the employee's net worth. And unless they are self-insuring, employers are probably paying a premium based on the number of families insured rather than the number of people in those families. Hard to see much, if any, likeness between this one and an employer (most often a government one, I think) paying out much more (salary + debt repayment) for an employee who incurred school debt and one who didn't (or one whose parents incurred the debt!).
#3 - amount of student debt as an indicator of the alma mater's prestige??? If there is a positive correlation in that one, it must be extremely weak. And why would a firm use an indirect and dubious indicator when they could base pay on the true answer, the US News and World Report rankings?
#4 - wouldn't both debt-burdened and those not burdened by debt (though their parents may be) be equally encouraged to take public sector or jobs with non-profits by the promise of greater compensation? I think it may work because people nod their heads in agreement believing it to somehow be "right," but I don't think it holds up to logical scrutiny.
#5 - equalizing take home pay. The smart thing for anyone aspiring to work for the government or another employer that will pay off student debt would be to take on all the student debt they could, wouldn't it? By doing so, they could look forward to "equal" take home pay, at the same time they would wind up substantially better compensated than those who had not taken on any debt. (Does the IRS tax as "income" this sort of debt forgiveness or pay down as it does under other circumstances?
As Martha Stewart would say, "A long-term loan at 3% is a good thing, from the borrower's perspective."
Lexington and environs: my experience of it is limited to a couple of visits in the fall, when it was really lovely.
civilisation and programmes? Did you grow up in another part of the world, one farther away than MA, perhaps across an ocean from here?
stressed out by meditation?? Don't do it myself, but that does sound worrisome. Type A+++, maybe. Funny that that which stresses out most 3Ls, passing the Bar, doesn't seem to be a concern of yours. And you're waiting anticipatorily for GERD?! You do need that summer break.
Isn't it cherry blossom season up in DC? When is peak time for that?
Trees are blooming here. Very pretty. I would send you a picture, but a) it did not come out well, as the sky is quite grey; b) I don't know how to upload pictures from my cell onto the internet; and c) I have no way of getting it to you. So I'll just have to say: take my word for it, Lexington is lovely in the spring (and moreso when it's actually warm and sunny out, not this cold wet spring we've been experiencing*).
Have you ever done the Skyline Drive? (The Waynesboro exit/entrance is about 40 minutes away from here.) Really lovely way to see the Shenandoah.
Bar exam: see, I still have to take the patent bar, too. Something else to worry about. Maybe I just have visions of sitting on the deck, looking at the water, and, instead of drinking pina coladas and doing the crossword puzzle with my dad, drinking pina coladas and studying for the bar. At least that's how I envision this summer happening.
As for being stressed by meditation: yeah, well, some of us are a little Type A. Some of us also need to be moving around. Last time I checked, there is no "meditative rush," but there is a runner's high. (The NYT had an article about it a few weeks ago, but it included some nonsense about how you need to run for 10 miles before that happens. Try two or three.) Then again, you're the neuro guy, so perhaps I ought to defer to you on that. :)
*Global cooling...?
The patent bar is the easiest exam you'll ever take as a patent attorney -- all the answers are right on the page and they're all in the MPEP. I recommend the John White/PLI class, for focused presentation of the material. Then practice the old exam questions until they start to look familiar to you.
Um, with a pass rate of something like 47%, I don't think that it can be called "easy." I mean, I have a serious love on for multiple-choice tests, but that pass rate (inclusive of tons of nerdy engineers, no less) freaks me out.
Neurodoc: That's an amazing time. (Really, it is. 1.6% overall, and, among men, probably about 2.7%. That includes up to three hours, though, so I suspect that the actual percentile is lower. You knew that, though!) Even at my best shape (years ago, before I completely wrecked my ankle), I could do 15 miles in two hours.
Does the boyfriend drink ridiculous amounts of espresso beforehand? (Look! Look! We're back on topic!)