Patri's Peripatetic Peregrinations

Cortisol Test results

Sat, 26 May 2012 02:25:25 GMT

The gray lines are reference ranges - cortisol production usually peaks in the morning, and declines all day. The black line is my results. If this test is accurate, I have extremely elevated evening cortisol (8.8 vs. standard range of < 1.5), which matches my symptoms of feeling "tired & wired" at night, and having some kind of HPA axis imbalance. Advanced stage 1 adrenal fatigue, for example. Or a negative association with sleep based on years of sleep apnea. This test was done a couple days after my worst week, I'm doing a retest/confirmation soon.

My other tests were fairly normal, my immune blood work was a little off, and my T3 was a little low, though other thyroid results were within range. I hear that different people are comfortable at different places in the thyroid ranges, and so I might want to try small amounts of supplemental T3 and see if I feel better.

On the incentives for alternative medicine

Wed, 09 May 2012 16:35:22 GMT

In the discussion on my adrenal fatigue post, steuard gave what I'll arrogantly call the naive view on alternative medicine:

But mainstream medicine at least tries to be driven by science, despite all the legitimate weaknesses that you point out. Homeopathic "doctors" have absolutely no interest in it, or else they wouldn't tell people to treat fevers by diluting mushrooms in water until there's no mushroom left and then drink the water. I have no idea what else they might do, but their medical credibility is pretty much shot in my eyes based on the nuttiness of beliefs that they do indisputably hold.

The same goes for almost every form of alternative medicine that I've seen (though few are as obvious as homeopathy). Snake oil peddling has a very long history, after all (and I wouldn't be surprised if some actual literal snake oil salesmen truly believed that their useless elixirs were effective). Yes, there are sometimes good scientific studies that show evidence for them working, but even perfect studies will find an incorrect result at the 95% level one time in twenty. If careful meta-analysis of independent high-quality studies gives a clear answer either way, that's what science is all about (and useful results will get taught in medical schools eventually). And there are plenty of scientists who specialize in studying traditional herbal remedies to identify compounds that are actually effective medicines (I think there's one in this building with me right now, in fact).

You know what they call alternative medicine that has been scientifically shown to be effective? Medicine.

He's missing something big, which is the way patents & intellectual property play into this. You can patent a drug or new procedure or medical device, you can't patent a vitamin or a centuries-old technique. That means that spending tens of millions of dollars to prove to the FDA that something works can only be done for drugs. A supplement company can't make back that money in sales, because every other company can cite the FDA approval.

Hence, there is a public good problem, hence "alternative medicine" (herbs, vitamins, and non-novel techniques like meditation, neti pots, etc) is under-researched. The fact that there is less evidence of efficacy stems directly from there being less incentive - it is *not* evidence that they are less efficacious.

This is not to say that alt med isn't full of snake oil. Of course it is - when there is less evidence, there will be more charlatans. But it is wrong to judge a vitamin by the same standards as a drug, because there will always be less money put into studying it, hence modest positive results (along with a plausible model of effect) are a good indication. Fortunately there is academic interest in alt med, and some private (and public) funding which addresses this public good problem - that's why we have data on many alternative treatments.

Also note that while the "private good" aspect of researching a patentable treatment means that more money goes into studying it, that money is also more tainted - the research is done by the treatment developer, who has a direct incentive to show that it works.

So the world does not consist of carefully proven scientific medicine and bogus alternative medicine. It consists of biased, large-scale trial evidence for patentable treatments, and less biased, smaller scale evidence for non-patentable treatments. That's a much more accurate view.

More life update - fatigue, sleep, stress, etc.

Tue, 08 May 2012 19:27:52 GMT

Since my last big post, things have still been pretty rough. I can kinda see the light at the end of the tunnel, but it's not getting closer very fast.

March & the first half of April were a strong uptick in energy, and I managed to clear some of my challenges. But moving & then nose surgery in the last week of April really knocked me out. I have so much less energy to draw on than I used to, I no longer seem to be able to take things like that in stride.

The nose surgery seems to have helped a lot with my apnea, my nose still swells regularly, but now when it does, there is still room to breathe. So hopefully that will manifest in better recovery over the coming months. Unfortunately, last week I had one of my worst weeks of sleep ever, feeling tired & wired every evening, exhausted but unable to sleep, tossing & turning all night long. It was miserable.

Ironically, what helped the most was going to a naturopath who (while giving me acupuncture and various herbs and such) told me I should take low-dose klonopin (the sleeping pill that has the least detrimental effect on my sleep) for awhile. I'd been decreasing my sleeping pill use the last few months, but as she pointed out, better pills than becoming a total wreck, which I was well on the way too. A few nights of that helped a lot.

There are a variety of potential explanations - learned insomnia (bad sleep associations from a decade of bad sleep), for which the solution is sleep restriction therapy. General stress/trouble relaxing, for which the solution is to lower stress and use sleep relaxation rituals such as meditation. Or adrenal fatigue (as I posted), for which the solution is to lower stress and use supplements to restore adrenal function.

I'm getting hormone tests (cortisol & DHEA profile during day from saliva) to investigate the adrenal fatigue hypothesis. I strongly suspect that my evening cortisol will be significantly elevated. I had one of these tests a few years ago, with moderate afternoon/evening elevation, but unfortunately I can't find it. I'm also getting some other standard blood tests, like thyroid function & hormone levels. I've started taking some vitamins in the afternoon & evening to lower cortisol levels: Vitamin C & Phosphatidyl Serine, as well as calcium & magnesium at night. I'm going to do another cortisol test in a few weeks to see if there's any change.

My sleep doc thinks that relaxation techniques would be more fruitful than restriction therapy, so I will try them. I'm also starting neurofeedback for insomnia today, which has some promising study results, and can supposedly retrain your brain to learn how to relax into sleep rhythms.

I tried cutting back on caffeine, nicotine, and kratom, with moderate success. I'm down to 1 cup of green tea a day, not going to have coffee for awhile, as caffeine puts load on the adrenals. Nicotine seems hard to reduce use of - who would have thought it? :). I've cut it and kratom in about half, though, on the principle of doing less stimulation of my hormones and putting less chemicals into my body, even fun ones.

I've started eating breakfast every day, and eating regularly throughout the day. While I still believe in the numerous health benefits of intermittent fasting, it works via a stress response which puts a load on the adrenal system. Fine for healthy people, but not for me right now. Here's some discussion on Paleo Hacks.

I've also started doing breathing exercises throughout the day when I feel stressed or twitchy, which I often do. One of my theories is that I've spent years trying to do a lot while not recuperating well in sleep, and as a result have put a heavy load on my positive stress responses (i.e. adrenals) through caffeine, provigil, and generating my own neurotransmitters through excitement (and things like tapping my feet, twitching my toes and fingers). As I've gotten more tired, I've stimulated myself even more strongly to compensate, which has come at a long-term cost. It's scary to relax, because I feel like if I'm not stimulated & alert, I will just fall down - which seems to be somewhat true, but if that's what my body is telling me, maybe I need to chill out. I've had several psychedelic experiences in the past year, on 3 very different substances, where all I wanted to do was lie down and do nothing (which never used to be the case). Again, my body was telling me something.

Anyway, there's more to report, but I guess that's enough for now. Still slowly trying to recover into something like the old energetic, enthusiastic Patri, while taking care of the kids & the basics, and working on accepting who I am and where I'm at right now. Spending a lot of time in Azeroth these days (Lvl 45 gnome Priest, Shadow/Holy, Inscription/Jewelcrafting).

Is adrenal fatigue real? Do I have it?

Mon, 30 Apr 2012 16:21:48 GMT

So, there's this very popular alt-med theory that high-stress modern lifestyles put too much load on the adrenal system, which eventually can't keep up, leading to chronic fatigue and related problems. The mayo clinic doesn't believe it's real, nor does the Hormone Foundation. But lots of others claim it is a real condition.

For whatever internet tests are worth, I score on the border between mild & moderate. My history also fits - years of increasing stress & long hours, met with high energy & enthusiasm (and stimulants, mostly caffeine), and not enough sleep, with a slow transition from stress being invigorating to being exhausting, culminating in a period of intense stress and work last year that left me physically, mentally, and emotionally exhausted, and have been unable to recover from (though there have been good weeks).

Adrenal fatigue supposedly explains the "tired & wired" phenomenon I sometimes have of being exhausted but unable to fall asleep at night (evening cortisol too high). I suppose I'll get a 24-hour cortisol & DHEA test.

Curious what y'all think. Is adrenal fatigue real? Should I go see an alt med doctor, or a mainstream doctor, or both? I'm starting Emotionally Focused Therapy tomorrow, hopefully that will be some good support in my de-stressing.

It's really frustrating to have gone from a constant bundle of energy to feeling exhausted all the time. There's so much I want to do, so much life I want to live, so much responsibility I've taken on. Chronic health conditions suck. And my life is not easy to take a vacation from (kids, for example), and I've already used all the slack I feel I have and more in the transitions of the last year. It feels like my reserves of energy, money, social capital, are all draining away. Though that's not really true. But it's a lot more true than I'd like.

steps forward and backwards

Mon, 30 Apr 2012 16:11:42 GMT

as I continue to slowly try to get my life together, I continue to have irregular progress. Last week was big in terms of important milestones: we moved, and then I had nose surgery (submucosal turbinate resection for my apnea). As far as short-term impact, though, the result is that I now live surrounded by boxes, and I spent several days last week totally wiped out from the surgery. Even though it was relatively minor, I'm much more fragile these days.

Sat night I fell asleep with no pills, and dreamed intensely for 3-5 hours, it felt like maybe the surgery was starting to heal and might actually be helping my apnea. I try not to be too optimistic about these things, because of my long and bitter experience solving this chronic issue, but it was promising. Then last night I was "tired & wired" and couldn't fall asleep until 5am. Today I'm a zombie. (Although, this isn't really counter-evidence to the surgery helping - "tired & wired" is a different issue than apnea).

I'm so tired of being tired all the time. I kinda wonder if I have adrenal exhaustion. I'll make a separate post.

At least I have sweet people to veg with when I'm tired, had a nice weekend with Brit, Tovar, and Izzy.

My 2 fabulous, remodeled units in the wonderful Tortuga Community are for sale!

Thu, 19 Apr 2012 23:12:07 GMT

Full ad, prices, info here. Information on Tortuga.

Property:

Layout (we are open to remodeling to re-split into 2 units):

More pictures, unit descriptions, prices, etc on the ad.

Online tagged collaboration database?

Mon, 16 Apr 2012 22:31:38 GMT

Is there an online collaboration tool which lets me add & easily search many snippets of tagged data?

The background is that I have dozens of seasteading talks, hundreds of pages of book drafts, and dozens to hundreds of blog posts, and Joe Quirk & I are turning them into a book. I'd like to store this information in a structured way so that if, for example, I want to find "evolutionary metaphors" for seasteading, I can just search for those tags. or "Examples of historical competitive governance". I want one-line summaries (titles), and the option to include text or links.

I could do it in one big Google Doc with special tag markers, but I hate loading a big doc, and I want to be able to search and just see the titles. Asana would probably work. A private wiki might be a good option (use category markers for tags), though I don't want to deal with markup (maybe a Markdown wiki?) My memory works decently at doing this, but it's far from perfect recall.

There are products like MindJet, but I'm not looking for visualization like mind maps. Googling for terms like [cloud], [collaboration], [brainstorming], [tagged] did not work so well…Maybe this is what Evernote is for?

Ideas?

Last year in the context of my life journey…finally starting to catch up!

Tue, 10 Apr 2012 23:35:25 GMT

As many of you know, I've been having a tough time the last year. My adult life has been one of increasing responsibility and commitment, and until last year, my capacity increased commensurately. Then my responsibilities went up, my capacity down, and like a too-big wave in a tower defense game, I got swamped.

Back in the old days, from 1998-2004, I thought myself lazy. Lived on a trust fund, did some cool projects (first seasteading book, ABL, failed online poker startups, got an MS in CS from Stanford), but didn't push myself hard.

Starting work at Google in 2004, and Tovar's birth in 2005, changed that. I started to use my energy & talents, to be excited about creating and producing, to sometimes have 12 and 14 hour days and feel good about it.

The transition to TSI in 2008 ramped it up quite a bit. From then until last August, 2011, I worked hard, traveled the world, had another kid (Izzy in 2010), and stretched myself to the max. And then beyond. Marriage problems from April 2011, side jobs doing angel investing & planning a cross-country bus tour, and then starting a company in August took me past my capacity.

Over a few short weeks last August, I separated from Shannon, left TSI, and the bus tour got cancelled. But from Aug 2011 to Feb 2012, it was a struggle. Depression and turbulent emotions sapped my energy, while the startup placed great demands on it. I moved to an apt near Tortuga at the beginning of Sep, and again to a house in Berkeley at the end of October, when I also took full custody of Tovar & Izzy.

Wanting rest & recovery for myself, an easy transition for my kids, and a new kind of relationship, without giving up my passion for my mission, I focused on my startup, my kids, and my new relationship with Brit. She supported me in every way - organizing, shopping, inspiring and distracting when appropriate. Most importantly, she supported me emotionally, defending me from myself when I felt sad, guilty, or perfectionistic, reminding me of my capacity for strength and love as a parent, partner, and entrepreneur.

But life was still a struggle. At the same time I was stressed & overwhelmed by this enormous life transition, major challenges kept arising: the complex divorce paperwork, staffing difficulties at the startup, the moves, potty training my kids, the sudden decision of my Tortuga renters to move out & thus the need to sell my 2 units, finding a new nanny, and other demons equally large but too personal or political to enumerate. Even opportunities like an exciting book deal were challenges, because they required my unique[1] and overdrawn energy. Bills piled up, doctors appointments passed, calls and emails went unanswered, and (literal) gray hairs began flecking my mane.

But things are finally getting better. At the end of February, I decided I was depressed, not burned-out[2], and the realization itself transmuted my attitude and mood for the better. Staffing changes and the slowness of a major partner have made our startup naturally transition to a slow-burn, lower-time commitment mode for a few months - perfect for my energy. Brit & I finished the lease on our gorgeous but too-big, too-expensive house, and decided to move again to an equally charming but right-sized house, and for the first time in my life, we're gloriously purging my accumulated mass of possessions. We found a wonderful new nanny for the kids and a very sweet (and much more affordable) daycare for Izzy during work hours. I started follow-up work on my apnea after my 2009 surgery. I've been cutting my spending. And I finally feel like I'm getting ahead, not just treading water and choking on the incoming waves.

And a good thing too, because the waves haven't stopped. Many big projects lie ahead: moving over the next 2 weeks, selling my Tortuga units, repositioning our startup, 2 corporate restructurings, writing a book, finishing the legal divorce, nose surgery for my apnea, and my 2011 taxes, which are much more complex than ever before, while still adding up to an income substantially less than my expenses. All while being a sole-custody dad recovering from life's 2nd most stressful event.

But it's all doable. I choose a full life because I love it, and I can handle it. It's been tough, and it will keep being tough, but I will get through the storm, and be stronger from it. The waves will never stop, but the odds are heavily in favor of smoother sailing ahead. And while tragedy is always just a car accident[3] away, the coping skills I've developed and the strength I've found the past year can get me through anything. I don't know my future, but I know my heading - what's important to me - and that's plenty.

My house and community are smaller now, but small is beautiful. My flecks of gray are distinguished. My "No" muscle is stronger. My challenges all came with lessons. You may not see me much this year, in-person or in writing, at parties or networking events, but rest assured that I'm still out there, growing stronger and wiser, raising beautiful children, and dedicated to the decades-long vision of enabling and creating radically flexible, decentralized, evolving societies. On the time scale of life, a year or two of struggle is still just a speed bump.

[1] My uniqueness has been a huge asset in my life, but it comes with challenges too - its really hard to delegate or remove myself from loops. I need lots of help and am missing lots of skills, but my unique projects also need my unique insight.

[2] Over-simplified difference: if you're burned out, you feel better when you let yourself rest. If you're depressed, you feel better when you make yourself go do stuff.

[3] The rogue waves of modern life.

Bet not looking so good

Sun, 25 Mar 2012 01:11:38 GMT

My Withings Scale came today - nothing like a wizard for quick wireless setup of A SCALE by USB to show that we're living in the future! You can now view my weight online here.

That's the good news. The bad news is I'm only at 115lbs, from a likely ~111lb start. A full week of stuffing myself, drinking several bottles of hard cider or lemonade every night, pouring sugar or maltodextrin into my coffee, sucking down fruit juice, chowing on potato chips, and I gained a measly 4 pounds! My stomach ached from fullness for the first few days, not like I wasn't trying.

At this rate (1/2lb a day), I could barely make it, but it's not worth it if I can't gain faster with this much effort. Losing weight is fun, and I'm looking forward to it, but not if gaining weight is so much effort. Any ideas? I make sure to eat all day, and have sugar first thing in the morning. I combine sugar & fat for insulin spikes + caloric load. I haven't had gluten, because it just hurts too much, so I've been having lots of rice and lots of liquid calories for my carbs. My stomach has expanded, but I don't always remember to keep it full, life is busy!

Will my fat gain accelerate as my metabolism changes? Should I be timing macronutrients differently? It can't be impossible to gain weight without gluten - sumo wrestlers do it with rice, fish, and beer.

It's not like I haven't been fat before - I've been over 140lbs. But that weight, I put on slowly. Is there a secret to fast fat gain that I just don't know? Maybe I need to reverse more of my diet & lifestyle principles.

Anyway, I'm gonna keep on trying sugar + fat, lots of liquid calories, and eating all day, in hopes of acceleration. At least I have good tracking now - I love the simplicity of the Withings. This is the Quantified Self I want - simple install, and no effort tracking, no making spreadsheets, no writing down data, no extra hassle. Just step on, wait a few seconds, and done.

p.s. If you're all "screw Patri for whining about not being able to gain weight, because I can't lose it, he's such a jerk", and you haven't tried paleo + weightlifting, then you don't have my sympathy. If you have tried them, you do :). If you think I'm metabolically lucky, well, somewhat, but go read about APOE4 and my future (some would say, present :) ) dementia before you get too jealous.

2 days of sugar & massive calories

Sun, 18 Mar 2012 18:31:47 GMT

I'm full all the time, and often mildly nauseous. I drink a lot of sugar water, to try to get calories even when I'm full. I pour sugar into my coffee. I pour sugar into my juice. My stomach doesn't seem to have stretched yet. The sugar tastes sickly sweet and kind of gross. So my taste buds haven't adjusted yet.

My Withings scale is in the mail, but I weighed myself at my dad's house yesterday and seem to have gained about 2 lbs, which is a great start.

So far, it's been entertaining but physically unpleasant. Hopefully I'll adapt, if not, I'll change my approach (loads of rice?) or give up. This is only worth doing if it's fun. If gaining fat turns out to be not fun, maybe I'll try seeing if I can gain some of it in muscle, with massive amounts of protein and intense workouts, a la Tim Ferriss Geek To Freak.

Even if I only manage 10 lbs up before I get sick of it, it will still be fun. I like losing weight :).

The yo-yo diet bet experiment: gain with carbs, lose with fat

Fri, 16 Mar 2012 20:06:44 GMT

Some of my diet history:

I've been eating paleo 2.0 for a year or two now, and maintaining the weight I had at the end of freshman year of college, 16 years ago (112 lbs). I've also (surprisingly to me), stayed ripped and muscular, even without much exercise (some pics in the video above). During the stressful last year, weightlifting fell by the wayside. I do occasional bodyweight stuff, but it's less than a full workout a week. But I ate 90% Paleo 2.0, and that worked!

The most relevant past history is that when Shannon was pregnant w/ Tovar, and I was at Google, I was sitting a lot, not exercising, eating free Google food, and eating 4 square meals a day to go w/ Shannon's pregnant metabolism. I fattened up from about 120-125 (my post-college, pre-Paleo/CrossFit equilibrium) to 143. At which point, I got my picture in the Russian edition of Marie Claire for being a fat Googler who wore pajamas to work because he was too fat for his clothes.

More recently, I've been worried about being too thin. I gained 10lbs in a week in 2009 before my jaw surgery for sleep apnea, to have some buffer, which was smart because I lost 8 lbs in the first 3 days in the hospital, with my jaw wired shot and on pain medicine. It was pretty fun stuffing myself with junk food for a week :).

And at my most stressed last year, the week after separating from Shannon, while working 3 jobs & preparing for Burning Man, I got down to 107, which I considered a bit unhealthily low. So at Bman, I poured grass-fed ghee on all the camp meals, to keep up my weight, and afterwards managed to get back up to my 110-112 ripped-but-not-gaunt equilibrium.

So the ingredients to this are:
- In the past, I got positive feedback for getting fat (picture in a fashion magazine!)
- I'm pretty good at losing weight, I have a set of principles (intermittent fasting, calorie timing, high-fat, paleo 2.0, weightlifting) that seem to work really well, at least for my body.
- I'm ready for a fun diet experiment.
- I want to confirm that I'm thin & ripped because of my diet (and not a tapeworm or something) by varying my diet and seeing if I get fat.
- Brit & I have been talking for awhile about doing a "body by butter" video, because I eat lots of butter and people think it's unhealthy. The weight-loss period would be great for that video - show me eating butter each day while losing weight.

Then Brit bet me I couldn't gain 30 lbs in 2 months & then lose it in 2 months, so it's on!

Some of my past diet experiments:
- A summary of the human research on intermittent fasting
- Trying to eat a stick of butter each morning (lasted 1 day, I was too full!)
- Shangri-La Diet, lost 12lbs in 10 weeks by taking occasional shots of extra-light olive oil.
- The olive-oil diet: After learning olive oil was the cheapest food per calorie, and per unit weight around, I tried living on it. I lasted 24 hours.

An interesting question is: what diet principles to follow to gain the weight? The key question to me is: do I eat poisonous foods (gluten, fructose) or not? I was originally thinking "I can handle a month or two of poison, I'll just eat junk food, and it will be fun". But I couldn't finish the Starbucks food above, and my tummy hurts now. I'm adapted to Paleo, I can't handle these damn neolithic grains. So, here's my plan, based on reversing many of my dietary principles:

- Minimal ketosis. Eat carbs first thing in the morning, and throughout the day.
- Lots of carbs. Make lots of insulin, store lots of fat. Eat carbs & fat to get the magic combo of insulin plus high calorie load to store lots of fat.
- Drink calories whenever possible.
- Eat more calories than I feel hungry for. Bloating / tummy pain is a signal to stop, not just fullness.
- Don't exercise. Don't move a lot. Be sedentary. Sit a lot.
- Eat modern poisonous foods (grains, fructose) as tolerated.
- If neolithic foods not tolerated, eat dextrose, rice, and potatoes in massive quantities for carb load.
- Track my weight with a Withings WiFi Scale

I'll post my weight-loss principles in a couple months, when it's time to cut. Call me weird, integratedly healthy, or masochistic, but I think the weight-loss is going to be more fun.

UPDATE: I'm going to get blood tests before/after, as some have suggested.

XKCD on Pickup & Personal Growth

Thu, 15 Mar 2012 18:32:26 GMT

I think this is a somewhat weak & incomplete critique of PUA (not to say that there aren't good critiques to be made, but negging is far from fully representative of PUA). But I think the "money panel" (bottom middle, especially the first paragraph) is a pretty accurate and incisive critique of a common approach to personal growth.

Although a bit too pessimistic for reality - it's more like "Nothing will ever change unless you change yourself or your perspectives in a far deeper way than any single tip or trick or technique or realization. It's not a missing tip or epiphany standing in the way of your dreams, it's who you are right now and how you approach them."

Update: Here's a response to the depiction/critique of PUA.

Learning from reality instead of school

Fri, 02 Mar 2012 06:12:47 GMT

My dad posts on A Better Way of Learning

Suppose you are a comfortably well off parent. Almost everything your child wants—toys, books, games—is available to be bought at what is, in terms of your income, a trivial cost. That makes it hard to do a believable job of teaching your child the importance of saving, of deciding which things he really wants and which he can do without, skills that he will need, as an adult, to function in a world of limited resources.

If your child plays World of Warcraft, he will learn the relevant lesson with no need for you to impose arbitrary limits. He will have a limited amount of gold and a considerable variety of things he would like to spend it on. Increasing that amount will require him to spend time doing daily quests, figuring out what he can craft and sell at a profit and crafting and selling it, or perhaps, if he is a mage, running a magical taxi service teleporting other characters hither and yon for pay. Whatever his effort, he will probably not end up with enough gold to buy everything he wants. Here again, the lesson works because it is, in its own odd way, real. These are the things he has to do in order to achieve the objectives he has himself chosen.

Follow-up sleep study: RDI much improved

Sun, 19 Feb 2012 20:51:59 GMT

I finally did a follow-up sleep study from my 2009 maxillo-mandibular advancement surgery for sleep apnea. Here's my 2008 blog post about my last sleep study. Subjectively, I've been saying that the surgery brought my sleep from a 3.5/10 average to a 5.5. The results seem to fit that pretty well.

RDI: 11 -> 10.6 -> 5.3 (all hypnopneas, no apneas).
Min O2 sat: 89% -> 92% -> 91% (avg might be higher, though - it's now about 96%).
Snoring: Yes -> ?? -> No

Sleep architecture is worse, though:

REM: 15% -> 10%
Stage 3/4: 9.5% -> 0.2% (though it varies a lot night-to-night, and my Zeo says I get stage 3 & 4 sleep)

They said hypnopneas were associated w/ mouth breathing, and that I might benefit from "tongue reeducation".

Childcare change, nanny ad

Thu, 16 Feb 2012 06:49:38 GMT

I'm continuing my life transition, learning more about how to set up my household with Brit & provide care for my kids, and my childcare goals/setup are changing a lot.

When I hired Teresa in October, I felt guilty about the divorce & being a working divorced dad with sole custody. I wanted the best quality, highest-hours caregiving I could get - almost a surrogate mom. I greatly appreciate Teresa's independence, long hours, and dedication, but she's found it to be too demanding a schedule, and I've learned:

- I want cost-effective childcare, which means Izzy in daycare, Tovar in after-school, and less babysitting. I have less money now, and less time to work, so lots of childcare is not financially sustainable for me. There was a period last summer when I was working 4 jobs at once & had some 80+ hour weeks. It was brutal, and I can't do that again for awhile. Now that I've gotten over the guilt, I'm accepting the reality that being a divorced working dad means (like for so many other single parents) that your young kids are in daycare.
- I want my kids to have strong parental bonds, and since Shannon is only willing to take them for a few half-days a month, that means me spending more time with them in these formative years, even if that means I can't be as much of a mission-obsessed workaholic, or have as much grownup time, or as exciting a life.
- I want a smaller, simpler household, so not a live-in nanny, even though that means I have to be home by 8-10pm almost every night, and do less travel & be out less. I'm a divorced dad, and it's time to accept the reality of how that limits my movements.

So now I'm looking for a more traditional babysitter/nanny, the ad is below. If you know a great nanny in the East Bay Area, please pass this on.

Looking for nanny to help with two wonderful kids: full-time, split shift, live-out.

Our household in North Berkeley currently consists of me (dad), my 6 year old son, 1.5 year old daughter, and my girlfriend. I am recently divorced and have full custody of the kids (mom has them a few half-days/month in Mountain View), and while I love spending time with them, I am also CEO of a small startup. So I work a lot of hours and sometimes travel for business. That plus a little bit of social life means I need help with dropoffs, pickups, evenings, and weekends, as well as light housework.

My son is in school/aftercare 9am-6pm, and my daughter will be in daycare 9am-3pm or 6pm. So we’re looking for someone who can handle these core hours:

Weekdays:
- Morning routine & drop-off, approx 7:30am - 9:30am, M-F.
- (Possibly) daughter 3pm-6pm, 3-4 days/week (if we can’t find a full-day daycare).
- Pickup & evening, 5:30pm - 8:30pm, 2-3 days/week.
- Evening lookout (8:30pm+) when I have occasional evening events / nights out.
- Night lookout: when I am traveling, you might sometimes sleep over in the living room for a few nights.

Weekends: You’ll have the kids about 1/3 the time on weekends, on average, based on mom visits, my travel, and my availability. This will range from occasional 24/7 weekends (if I’m traveling) to nothing. A typical weekend might be something like: mom drop-off 11am-1pm Sat & 8am-2pm Sun.

There will also be occasional school holidays when I’m working, where I’ll need help 8am-6pm or so.

There are some misc details below. I’m happy to answer any questions so that we can have the right expectations & clarity about the role to see if it’s a fit.
We’re looking for someone who wants to do more than just attend to the kids’ physical needs: who will teach them mental, emotional, and creative skills, take them to stimulating places, monitor their health & development, etc.
We currently live in North Berkeley, will likely move closer to the University in the next few months.
We’re most interested in applicants who’d like to do light housework as well to keep our home neat: dishes, picking up after the kids, laundry.
We’re potentially open to live-in for extraordinary candidates who want more time with the kids (less day-care / after-school) and more of a role in their development, and who click really well with my girlfriend & I.
We’re potentially open to having the eve & weekend time at your home, for example if you have kids.
The position will start in the 2nd or 3rd week of March.
We’ll initially screen candidates based on your resume/cover letter. Second stage would be an in-person interview. Final stage would be to spend some time with the kids.

Candidate will:
Basics: have a driver’s license, CPR certification, good English, childcare experience with young children.
Be enthusiastic to help kids grow and develop, teach them self-reliance, emotional intelligence, reading, and other skills, find them stimulating classes.
Derive deep fulfillment from spending time with wonderful children and creating a good domestic environment, be happy to have it be their full-time job.
Be highly responsible, with a strong work ethic.
Be flexible on evening & weekend availability.

Pay Range: $400 - $1000/week, depending on experience, skills, and total hours. Child-related expenses will be reimbursed.

About the kids:

My daughter is a happy, adorably cute 17-month-old girl. She is very social and loves to say hi to everyone - she is also very mobile, and really enjoys walking. She is just learning how to talk, and while she doesn't have the best articulation yet, she picks up on new words very quickly. She needs a warm, loving, interactive person who will show her new things and tell her about everything that's happening around her. Someone who will let her explore and figure things out for herself, while still keeping her safe.

My son is an intelligent, high-energy 6-year-old boy. He loves to play Transformers, Star Wars, and other games involving imaginary play and lots of movement, he loves drawing and building things, and he also enjoys his iPad time. He is in Kindergarten, and is excelling at learning how to read - like his little sister, he picks up on concepts very quickly and has an extremely good memory. He needs a calm & patient person who will play with him, but will also work with him learn how to cope better with conflict and his strong emotions. Someone who will continue to help him grow mentally, emotionally, creatively, and physically.

Happy Holidays!

Thu, 29 Dec 2011 19:33:14 GMT

Took the kids to see Grandma Diana (my mom) in King of Prussia, PA, for Xmas, as well as my 4 siblings and their significant others. My family did wonderfully at playing with the kids so I could rest, and it was nice to lounge around in my childhood home, surrounded by the bustle of family, and catch up with them. I hope to visit more often as the kids get older.

The flights there and back - taking a 6 year old & a 16-month old by myself - was a bit draining, but the kids were angels & I was super-dad, improvising games, diaper rash cream, special massages to get Izzy to fall asleep on the plane, and managing to pack all of our stuff into a single checked bag, etc. I got compliments on my bravery, and the good behavior of the kids. Izzy was amazing, charming passengers all over the place with her smile and cheerful "Hi!".

Now we're in Palm Springs, visiting Shannon & her mom Brenda, so the kids get to see both grandmothers for the holidays, and get some time with their mom, which is great. I'm also looking forward to getting home tonight to Berkeley to my comfortable base there. For pics of Tovar & Iselle, friend them on FB, I tend to use that rather than LJ. Here's my favorite recent one:

From Misc 2011

The merits of skipping breakfast

Fri, 16 Dec 2011 23:48:59 GMT

From the new Carb Back-Loading Ebook that my friend Nthmost helped produce:

Chapter 14 - Best Breakfast Ever - None

Inviting a bout of vitriol is as easy as standing in front of a fitness guru or strength coach and mentioning that there might be benefits to everyone if they skip breakfast. Why the anger? I have to be honest, I really don't know because my reason for suggesting a start to the day that does not include an immediate calorie load stems from how the body works and the resulting research to prove the effectiveness.

If you’re like me, you’ve skimmed ahead and noticed something peculiar: I spend more time on breakfast than other topics—this chapter is two to three times as long as other chapters. Eating (or not eating) early in the day dictates the metabolic status of the body for the rest of the day. Breakfast is simply that important.

By skipping breakfast, it’s easy to change several aspects of the metabolism, like whether the body burns fat for energy or carbs. I do realize that the gurus across all folds, from medical doctors to bodybuilding coaches believe that breakfast is essential, preaching it with zeal. Sometimes, it sounds as though death may occur from skipping breakfast after some of the harangues I’ve heard, but the facts don’t agree and don’t lie.

It then continues to a technical discussion on the endocrinology of why the morning is the best time for fat burning, and how breakfast interrupts it. Something new to me was that even protein can contribute to this, and recommends that if you eat anything, you eat pure fat. Sounds like Bulletproof Coffee is the perfect way to start your day!

Also validation for Warrior Diet-style eating:

From the massive number of trainers and doctors teaching to eat breakfast and not eat before bed, I’d expect them to base such advice on scientific research. The research does exist to answer the question, Should we eat more in the morning or in the afternoon? There is, however one problem: the research says don’t eat the majority of calories early in the day, eat them at night.

The current advice is a remnant of a reasonable assumption based on reasonable logic that no one ever checked. The logic: when first waking, the body is starving from the overnight fast; feed it and it’ll start burning all those calories right away. But before bed, the body’s going into torpor for hours and won’t burn any calories, so don’t give it any food and it can’t store it.

Research shows something very different. As far as body weight is concerned there’s no real difference between eating calories early in the morning and few at night or vice versa. But checking the difference in body composition tells a very different story. People who eat a big breakfast and start fasting at 7pm lose mostly muscle tissue. People who skip breakfast and eat after 7pm lose body fat and may actually gain muscle.

Here's the study.

Now I'm a true paleo believer - Stable weight, eat whenever I want

Fri, 28 Oct 2011 01:37:32 GMT

So, I have to admit, I never fully believed in paleo. To be more precise, I always had the intuition that if I followed my hunger, I would eat too many calories, and I would gain weight.

I always thought paleo was easier, healthier, better, and I have mostly followed it for years. But I also checked my weight a few times a week on the scale, and I adjusted my fasting and hunger-fighting based on how my weight changed. It wasn't a lot of effort, but there was some for sure. My thinking was probably based on my having gained 25% of my bodyweight in the past (long before paleo), and - through diligent effort and fasting and more than a little life stress - gotten to my lowest adult weight ever. So I assumed that weight control required effort - even after reading all those paleo books, I didn't quite believe.

The funny thing, from a self-improvement standpoint, is why my change happened. It wasn't one more book, or a rational decision to do a test. Rather, I moved, and my new apartment didn't have a scale. So, I stopped checking my weight. Second, I started shopping at Whole Foods & Nob Hill and getting delicious high-end food to stock my fridge in my new apartment. That's it - random life events.

The result? I didn't check my weight for 2 months, I ate tons of food (or at least, it felt like I did) because there was so much yummy food around all the time, I glanced at my body every now and then to confirm it's still ripped, and when I finally got around to checking a scale, I was at the same weight I'd been maintaining for many months[1].

I probably don't actually eat that many calories, even though I feel like I eat all the time, but it's the first time in my life when I feel satiated basically all the time and am never fighting hunger. I only get hungry when I am obsessed with work and forget to eat (which happens a fair bit during the day). At night, I often eat 3-4 small meals, because there are so many tempting treats around. I even eat breakfast sometimes now, and lunch much more often than I used to.

Oh, and I don't work out much, and I stay ripped - Dave Asprey's "be ripped by eating butter" theory seems to work for me.

One major caveat is that I have an unusually good response to paleo compared to people I've seen, possibly related to my dual-APOE4 carrier status (a "primal gene" related to lipid transport).

Major constituents of my diet are: grass-fed butter, cream, frozen mangoes, berries of all kinds, grass-fed cheese, prosciutto/pancetta, eggs, butter, crackers made entirely of cheese, carrots, sour cream, root vegetables, coconut oil, and butter. I carry butter in my bag, to add to soups at restaurants, and melt onto hash browns. I'm not eating a lot of meat, just because I mainly eat raw no-preparation foods, but I get steaks & sashimi when I'm eating out.

The diet isn't perfect - I still have occasional digestive upset, which I haven't taken the time to track. I worry that I eat too much dairy (casein). We'll see what my blood levels are in my Jan physical. But it's been super-satisfying & super-effective in general!

[1] I had been steady around 110-112 for awhile, then after a horribly busy and stressful week in late August, I lost 3.5lbs in a week and was down to 107. My weight when I checked? 111 lbs.

twitter

Mon, 19 Sep 2011 22:41:21 GMT

just FYI, for those who haven't checked it out, I do more tweeting than LJing these days, as it's quicker/lighter-weight:

@patrissimo

i.e. last few tweets:

"Effect of transdermal nicotine administration on exercise endurance in men" bit.ly/owsfLu
Post from my dad defending gestational surrogacy (the clinch argument is a picture of Iselle :) ) bit.ly/mXsXTW
Paleo coffee tip: order your cappuccino "breve" to get half-n-half instead of milk. (no equiv word for "cream", tho).
wow, I haven't lifted in 26 days! Diet still keeps me low body-fat for the visual aesthetic, but I've lost strength. Time to pump iron!
Is teaching obedience really the way to teach self-control? bit.ly/ptD4Jh
RT joelgrus Joel Grus "If they're lying to you about the Food Pyramid, WHAT ELSE ARE THEY LYING ABOUT?!"
Learned last week to order latte/cappuccino w/ cream instead of milk! Extra-delish, extra-paleo, and nice contrast to "non-fat latte"
Good advice for life from Miss Manners about appts of any kind: "Come on time. But bring a book."
And we're in New Yoooork....concrete jungle where seasteaders meet up...tall buildings inspire you, there's networking to do…

What it takes to be a CEO

Sun, 18 Sep 2011 17:38:30 GMT

From a comment on half sigma's blog, about how people don't have a visceral feel for what "a CEO can do that many people in the college graduate class can’t also do."

Believe me, it is VERY difficult to be a CEO as the company scales. The key difficulty is *context-switching*. For example, here are certain tangible job requirements:

1. You need to work every day. You are always thinking about the business.
2. You need to be the ultimate manager for every thread in the business. That means R&D, sales, hiring, facilities, web development, media, and so on.
3. You need to hire the right people, yet have enough breadth and depth of expertise that you can contribute productively in these areas if one of the managers doesn't know how to get something done.
4. You need to be able to switch contexts to do several different things in a day. One minute you might be haggling over a supplier contract, and the next minute someone will come to you with a hiring issue.
5. You need to be almost immediately responsive to every email requiring a decision, with hundreds of incoming emails a day.
6. You need tremendous energy reserves and work ethic. Do you surf the web? Do you watch TV? Do you procrastinate? Then you don't have what it takes to be a CEO (and neither do I). Blog surfing is out of the question. CEOs are both highly intelligent AND ruthlessly focused. This focus is orthogonal to IQ -- basically you need to keep alternating between doing the next thing on the todo list, and rewriting the list. Moreover, you need to do this on mornings, nights, weekends, and holidays. Easy to say, hard to do.
7. Because you are setting the direction, you take the ultimate responsibility for the company's success or failure. If you don't work hard, no one else will.

Some of these come naturally to me, others I struggle with. A hard package, for sure - rare to find the combination of creativity & focus.

commenter continues:

In short, anyone who thinks a CEO is easily replaced with an average college graduate is VASTLY mistaken. They have been suckered by the same anti-business media propaganda that honors rap artists and promiscuous celebrities over scientists, engineers, and capitalists. It is as ludicrous to think that your average leftist blogger with a Columbia degree could run a 100 person business -- let alone GE or Google! -- as it is to think that he could be the point guard for the Lakers.

And that's the underlying assumption in a lot of business critiques -- hey, isn't management stupid and Dilbertish and replaceable? -- but the thing people are missing is that if it's *really* stupid, then the company is eventually out of business.

Start a startup, get it to scale to 100+ employees with $100M rev, and then tell me how easy it is to be VP of engineering, let alone CEO.

Or talk to the kids at Ycombinator sometime. Ain't easy, even for the top of the top MIT, Stanford, and Harvard grads.

The Lakers analogy is great. Sure, it's easier to get lucky in one company than in hundreds or thousands of basketball games. But there is much of the same ruthless selection pressure, where those around you see your performance day in & day out, and decisions about partnership, funding, employment, etc. all reflect evaluations of that performance. The skills of creation, leadership, and management are not as visceral as ball-handling, profit is more abstract than a ball going through a hoop, but it is a great fallacy to think entrepreneurship is easy.

Fortunately, hard things are fun!!!

When you're named Izzy

Mon, 12 Sep 2011 03:38:28 GMT

From Misc 2011

'Cause everyone's your friend / when you're named Izzy,
And everyone says: beautiful! / she's so young and pretty
your future's bright as diamonds / there's just so much to see
But the best thing about Izzy is…when she's with me.

semi-farewell to LJ & non-strategic blogging

Sat, 10 Sep 2011 06:02:04 GMT

I dunno about this LJ thing.

I like deep personal conversations. I like working. I like reading & reflecting.

I also like writing. And I think of lots of things I want to write, all the time, but do I want to take the time to write them? I have writing projects that I think could sell tens of thousands of copies / be read by hundreds of thousands, if done with the proper marketing & partners. That marketing is more work, and different work, but doing 50/50 marketing/writing instead of 1/99 will only halve writing output and could easily increase readership by an order of magnitude. That's the strategic way.

Blogging has been a refuge from strategicness for me for a long time. I wrote what I felt like, when I felt like it. I didn't worry about crafting careful messages or convincing arguments. And yet, it brought me enormous returns - my connection to Peter, funding for TSI, and my leap into full-time entrepreneurship, plus many satisfying friendships, ideas, and connections.

But as I try to do more & more ambitious things, to pack more work, rest, love, play, and connection into the 24 hours each day that is all we have, there is less & less room in my life for un-strategic things. And so I have been posting less & less. And I think I will likely be on semi-hiatus until I get my personal website & non-LJ blog up. Then, posting will at least be building my traffic & readership for my site.

But the posts will probably be different, for a variety of reasons. More strategic. Less personal. Less trolling. Less raw. Less genuine. I'll miss the old way, but I don't think I need impersonal sharing as much anymore - I'm finding personal sharing to be more satisfying, and with less collateral damage.

It's the end of an era…I'm 35 now, time to grow up a bit. Sorry for those who will miss the old LJing patrissimo - take consolation in knowing it's a strategic choice for a variety of outcomes that you likely favor (like my positive impact & productivity on causes where we share an interest). And when I'm a billionaire, I will (strategically) consider going raw again. Until then - blogging diet!

single dad week - not easy!

Mon, 05 Sep 2011 18:53:52 GMT

Why did I think my life would be easy & focused when I got back? Shopping to fill an empty space for me & 2 kids, while having 2 kids (home from school for Labor Day) in that empty space, is…somewhat challenging. Thankfully they were great in the grocery store, sitting happily in the firetruck cart while I got $460 of groceries for my empty kitchen - which is not all I need, but the cart (& car) were full & kids getting bored, so I stopped early.

Now Izzy needs a diaper change, I don't know where in the stuffed car the diapers & wipes are…sigh. breathe.

I'm happy to be the one leaving Skullcrusher for a new space of my own, but it sure is a lot of extra work! And I chose to spend my first week of no parenting at burning man, so aside from 1 day (yesterday), I'm doing it while having the kids…quite an adventure.

Thank goodness I don't have to pinch pennies, I have the assistance of my assistant Brit, and Shannon & I are on friendly terms. I shudder to think of going through this on a budget, truly alone, and with an angry spouse, as many people do.

Oh, and I slept 6 horrible apnea-filled hours, and I'm getting sick. Good thing I'm superhuman!

changes

Mon, 05 Sep 2011 06:39:11 GMT

I left for 1 week - the first of me & choiceful's alternating weeks of parenting.

Tovar lost his first tooth, and Izzy learned to walk.

Guess I need to get used to missing half the developmental milestones.

Goddamnit Patri, stop whining and go to bed!

Great adventures, somewhat cranky

Mon, 05 Sep 2011 06:29:02 GMT

Wonderful adventure yesterday flying back from bman (thanks Greg!), and meeting w/ my co-founders Joe & Fred. Great adventure today spending a grand at Ikea (w/o getting any furniture!). But am also rather tired and cranky. Sleeping in the desert does not work so well, and I seem to have quite a few of the major life stressors happening:

End of job - yep, twice in last month
End of marriage - yep, 2 weeks ago
Moving - yep, just moved
Death or illness in close relative - Illness, turned out well fortunately.

And I have an ambitious startup pursuing a huge & time-critical opportunity.

So, if you don't hear from me much, or see me much, or if I'm bitchy when you do, or you were bummed I was so antisocial at bman, or if I don't answer your emails or FB messages or phone calls or interview requests (except for The Economist - looking forward to that one!), please understand. I'm doing what I need & focusing on my foundation & what I love, and this involves a LOT of triage.