Ok, I think I'm finally ready to do some quantified self-style intervention testing on my sleep. Slept really badly last night, and pretty badly the last few, feeling really tired (but not as bad as I would be w/o Adrafinil!).

I think this will be really good b/c instead of acting according to numerous vague and unknown theories, I can actually test them. Then I can use the things that work and abandon the things that don't, instead of wondering every night which of 17 things I should do.

I feel guilty about not having done this yet, for some reason, but it was actually a strategic decision. My sleep was so bad before that nothing seemed to work, so there seemed to be no point in testing anything, plus I had no energy to test. Now that I've had the MMA surgery, my hope is that behavioral and minor physical interventions can measurably affect my sleep. Plus I have more energy to do this.

Anyway, I am open to feedback on my experimental plan. I think I have a pretty good hypothesis pool, so I am most interested in feedback on outcome metrics and the general method.

(I feel somewhat guilty working on this during work time, but then I remind myself that sleep is by far the largest factor in my work productivity - improving my sleep would be like hiring another 1/4-1/2 of a Patri, which is well worth my time to work on!)

Pain: I still have significant jaw pain. It got better for awhile, but with FreedomFest and all the talking I've been doing the last few weeks (it's part of my personality and part of my job), it's been hurting quite a bit. My latest thing is practicing talking quietly, because energetic talking is what hurts the most. If you see me talking really energetically, please make the universal hand signal to reduce the volume. Anyway, it's a good habit to develop, so I'm more aware of my volume levels.

Food: I eat whatever I want, and have for awhile. This may contribute to the pain too.

Sleep: Not great, maybe not good, but definitely better. Two things I've really noticed - I have a lot more trouble falling asleep at night, and a lot more trouble sleeping in in the mornings. I used to be able to go back to sleep, if I didn't have anything to get up for, until I'd been in bed 10 hours or so. Now, it's hard to sleep more than 8 or 9. I still get noticeable apnea episodes sometimes, though, especially towards the morning.

My sleep still sucks. It's about like with the dental appliance before (though better than without the dental appliance). This makes me a little pessimistic about whether the surgery will help me. However, it is still very early, only 4.5 weeks. Sleep improvements are supposed to start showing up around 3-4 weeks, with significant improvements by 8 weeks, and continued improvement for 6 months. (They won't even do a follow-up study unless it has been at least 6 months). So, it's early.

Plus I've been fighting off this cold for the whole 3wk+ period, and other blogs I read had people regressing from colds or allergic swelling even after 6-10 weeks of healing.

I see 3 major possibilities:

1) The surgery will help, it just needs more time to heal / my cold needs to go away.

2) The surgery will help, but I need to unlearn bad sleep.

3) The surgery will not help.

Fortunately, the procedure here is pretty straightforward.

* First, chill out and wait another 3.5 weeks before worrying too much about (3). This will give a lot more information on (1).
* Then, use one or both of two procedures to attempt to unlearn bad sleep: (A) Sleep deprivation (cut down on sleep amount until I am sleeping solidly due to extreme exhaustion, then slowly increase it), (B) Sleeping pills (Ambien XR probably, benzos are more addictive). (A) sounds less pleasant (I like sleeping pills - they make my shitty nights pass quickly), but I think it is significantly more likely to work, so I'll probably try it first.
* If neither of these work, see what the results are from my follow-up sleep study (in 6 months), and start doing some more research, both in conjunction with my doctors, and self-tracking / self-experimentation.

slept 11.5 hrs last night, no drugs (other than liquid vicodin a couple times - but no sleeping pills). I feel more tired than rested, but that's normal for sleeping in, I think. Maybe I'm starting to catch up on sleep? I woke up pretty often.

mostly I'm focused on the pain right now, but I should add, since after all it's the important thing, that I do think that this is helping my apnea. It's hard to tell b/c my sleep is shit w/ the pain & narcotics, so it'll be weeks before I should actually have net positive sleep. But I definitely feel air moving much better through my nose, even when it gets a little congested. Someone used the metaphor of: it's like breathing through a straw, and then you are breathing through a fire hose. It does feel a little like that. There is way more power to pull through obstructions.

Anyway, who knows if this will translate into better sleep, but I don't think I'd mentioned it yet so I did want to specifically say that I can feel my breathing has changed for the better, it ain't like I ain't feelin' no benefits yet.

This is based on my reading. I am younger and healthier than most people getting the surgery, so there is a good chance I'll be on the short end of all of these, but I don't want to count on it. (For example, my Dr. doesn't think I'll need to stay in the hospital overnight, whereas every MMA blog I read had at least 1 night).

• Work:
  • Back on the computer for short periods of time: 1-4 days.
  • Able to work for an hour, 1-3x a day: 1 - 2 weeks.
  • Able to work full-time (on computer): 2 - 4 weeks.
• Sleep / Breathing:
  • Starts to improve: 3 - 14 days.
  • Significant improvement: 1 - 3 weeks.
  • Improvements plateau: 4 - 8 months.
• Food:
  • Want to eat anything: 1 - 3 days.
  • Eating blenderized solid food: 1 - 4 weeks
  • Chewing some soft food: 1 - 2 months
  • Able to chew steak: 3 - 6 months.
• Talking:
  • Able to hold short conversations: 3 - 21 days (most of the MMA bloggers don't report on talking, which is annoying, because it's such a huge deal to me, both for work and so I don't go insane from trying to keep my big mouth shut :) ).
  • Moderate conversations: 3 - 6 weeks.
  • Long conversations / talks: 2 - 4 months.
• Exercise:
  • Mild physical activity: 4 - 10 days
  • Vigorous exercise (but w/ no risk of hitting face - so deadlifts and squats but not presses or cleans): 2 - 6 weeks.
• Misc:
  • All bruising gone: 1 - 3 weeks.

Alternately, here is a timeline of phases

My greatest fear is that it won't make my sleep better. I can deal with complications, numbness, pain, annoying recovery, but if my sleep is still bad, and I have no idea why...that will be awful to face. I'm actually expecting old sleep problems (racing mind, trouble getting to sleep) to re-surface if my sleep quality improves, that's fine. Those can be dealt with through meditation, ambien, that sort of thing.

But I think it's pretty unlikely, I really notice my airflow problems nowadays. Even during the day, my nose will get a little congested and I'll have to stop breathing through my nose. Now that I'm conscious of it, I notice that I start getting that slight drowning icky feeling of not getting enough air, and that leads me to switch to mouth-breathing. And it's the same thing at night.

Anyway, this will probably turn into an MMA blog for awhile starting next week...when I start talking about other things, that will mean I'm feeling better? Hmm, unless I'm just ranting and arguing, I do that when I feel bad. If I talk about things that aren't MMA or ranting or arguing, then I feel better :). (I know MMA means something very different to some of you, which just makes it more fun to use as a term :) ).

I am so glad I have my apnea surgery coming up. Every morning (well, maybe 60% of them) I wake up feeling crappy and think "This sucks", and then I think "But I'm doing something about it! Soon! Yay!"

My sleep has been noticeably worse since I got back than in Panama. I've had a bit of a sniffly nose and felt like I was fighting off a cold, so that's my top theory, but it could also be some other environmental difference, like allergens (hotel room bed changed daily vs. my sheets every two weeks, or I'm more allergic to CA plants), or heat (we don't have our A/C set up, and it's quite warm out, so the house has been unpleasantly hot for me at night).

The cost is going to be somewhere between $45K and $72K, which is a lot (more than I'll make this year in salary, though probably less than with poker and investment income, though those are highly uncertain of course), but totally worth it as far as I'm concerned. I am so excited to be so close to rolling a die which I think has a roughly 60% chance of having a huge positive effect on my life!

not looking forward to trying to sleep tonight or get up tomorrow...my nose is still quite congested, I'll probably have bad apnea again. On the plus side, I think I'm moving through the sickness fast, ie my throat was only sore for half of yesterday and not today. Hopefully my nose will be better in a day or two.

Also I have an ouchie where I lost some skin on the side of my noise from peeling off a breathe-rite strip, so I will have to be extra careful with my placement of tonight's strip.

anyway...flight was comfy and went quickly, and I got a couple hours work in, but I am pretty zombified and pessimistic about prospects for de-zombification tonight.

this was one of the worst mornings I've had in awhile. Got to sleep late (1ish?), had lots of apnea, got up at 7ish. Had another 30-45min I could have slept, but apnea sleep can be worse than no sleep at all so I just got up. Was so zombified. Took the train, fortunately.

it's a good reminder that most days aren't like this...or most nights, or most mornings. It could be worse. I've talked to people who have much worse apnea.

I think it was mostly likely playing with Lucy (our pet chinchilla) right before bed. She was really friendly so I played with her for awhile, I might have gotten allergies from that. Or could have been something else, who knows.

bleh. I feel very crappy.

bad - slept poorly, lots of apnea, ended up missing an important morning appointment :(.

good - had very vivid dreams due to new sleeping pill. vivid dreams allowed me to be conscious of waking up from apnea. memories of dreams were so vivid when I woke up that I could recall what I had been doing in the dream, including being yanked out of it by not being able to breathe, going through a semi-conscious period, then fully waking up. This was nice b/c it was further evidence of apnea being at least part of my sleeping problems.

bad - feeling very busy today, tired, slow

good - today is Tovar's first Tuesday at pre-school, he is 5days/week starting this week. Very nice to have a quiet house and more time for S&I to be productive.

Saw my surgeon again. He took a look at my airway with a fiber endoscope, said it is bad - looks worse up close than on the xrays. We talked about my small nose, he said the jaw surgery expands the nose, because it sits on the bone and the bone moves forward.

He said that while my numbers aren't bad, different ppl have diff arousal thresholds - their brains are more or less bothered by respiratory disturbances. (After all, we all have some sleep disordered breathing, it is a continuum). I find it easy to believe that I have a low arousal threshold (mentally speaking).

He said given my age and subjective view of effect on my life, he supports doing the surgery. We will apply for insurance coverage. If that doesn't work, the combination of cash discounts and tax writeoffs should bring the cost down to $30k-$40k, even at Stanford, or less at a surgery center. (He uses stanford if ppl have insurance, but sometimes a surgery center if they don't).

Pic of my airway: here

It came yesterday and I wore it last night, although it ran out of memory after 8 hrs b/c it was set to 1-sec intervals. I'm going to switch to 2-sec. I haven't looked at the data yetr b/c I need to install a windows program and sync data, the unit offers no summaries.

Anyway, I am looking forward to it. I am excited that it focuses on a single sleep issue: apnea, because that simplifies a complex problem down to what I believe to be the current key element. The oximetry data will only tell me about apnea, not noise, having trouble falling asleep, and other sleep disturbances.

My goal is to get some baseline ranges pre-surgery, incl. with/without CPAP, breathe-rite strips, Ambien, and other things that I think might affect apnea.

At sleep clinic getting second opinion. They said there is a less invasive version of MMA called palate distraction where they expand your airway laterally rather than forward (anteriorly?). You get a gap in your teeth which can be fixed with braces. She said I should talk to surgeon about that. Given that I am young, it is affecting my QoL, I have tried everything else that they think is a good procedure, and I can afford it, she definitely recommends I get MMA or palate surgery.

Second doctor was contrary. She was concerned that I didn't respond to CPAP, wants me to try cpap + sleeping pills, to make sure my bad sleep is an airway issue, before doing a jaw surgery. Sigh. I can feel it sometimes at night, lying in my bed exhausted, and just not getting enough air, feeling like I'm slowly slowly drowning. I mean, I'm sure I have other sleep issues besides apnea, I'm hyper, I'm a night owl, but I'm also pretty sure I have apnea. Cpap responsiveness is relevant, sure, but you can have apnea and not be able to get used to cpap.

Both docs agreed I have a small jaw and airway, and that airway issues can impact sleep even with low numbers of apneas like I have (rdi of 10 all hypnopnea no apnea).

Part of my issue with this path is that if I can get cpap to work, that's *more* reason to have the surgery (higher certainty it will help). So we are trying something else, which, if it works, will lead me to do what I want to do now. The reason is that if it doesn't work, then maybe I don't have apnea and we can look for obscure reasons why I might sleep badly.

Suppose that my noncompliance w cpap doubles the chance that jaw surgery won't help. It is 90% effective! So that gets us to 80% - still well worth it to me. I have an appt w/ my surgeon next week, and the sleep clinic doc is going to discuss my case with him and email me, so we will see what their collaborative opinion is. I'm happy to try the sleeping pills plus cpap route for now because it is immediate, but unless my surgeon changes his mind after talking to doc 2, I will prob go ahead and schedule the jaw surgery.

The attitudes of the two docs were interestingly different. The first seemed to understand how big a QoL impact this was and how miserable it is compared to the surgery. The second seemed to be looking for any reason not to do the surgery. I can certainly understand being conservative with a lesser health problem or a newer one, but for something this serious, that I've had for 8 years and tried a zillion things to fix, it doesn't make sense to me.

p.s. it is interesting how my low RDI can go either way, you can read it as "maybe apnea is not my sole / primary cause of poor sleep so surgery won't work", or you can read it as "the respiratory disturbance is low, therefore surgery is likely to work." That is, the low RDI makes it less likely that my poor perceived sleep quality is apnea, but if it is apnea, it makes is more likely that the surgery will fix it completely, as it is only a small disturbance in my airflow.

been sleeping extra bad recently. very tired. ordered oximeter for $299.

I see there are 60 comments on my troll-tagged post. Have thus far made my saving throws and avoided looking at them.

super-exciting seasteading-related meetings this morning. lots of coffee. coffee and excitement wearing off, am v. tired.

have appt w/ Stanford Sleep Clinic next week to get second opinion on jaw surgery, and appt w/ my surgeon the following week to proceed in whatever direction I decide, so I do have hope for the future, heck, not just hope but am actively proceeding towards getting more treatment. Trying to keep that in mind to provide some glow in the grey fog that surrounds me. Also, this time of the afternoon is the toughest, I should perk up a bit later.

I might break out my old CPAP machine and try it. I've had several surgeries since last time I tried it (6 years ago?), and supposedly they can cause it to work. Never helped me before, but seems like it's worth a try for the short-term if nothing else.

I don't think I'm going to make Liberty on the Rocks tonight, even if someone else drove. Oh well, I'll make it one of these days.

One thing I was thinking of doing before getting the crazy surgery is monitoring my oxygen levels when I sleep at home, to confirm that I do have consistent apnea. At least one study has shown that home oximetry measurement is just as accurate as a sleep study in diagnosing apnea (specifically: in predicting whether people suspected of having apnea will respond to CPAP treatment). (Which is a good example of the cost inefficiency of our crazy third-party payer health insurance system - renting an oximeter for a few weeks would cost tens of dollars, a sleep study costs thousands).

There are oximeters below $150 in price, but the only one I've found that has memory and talks to a computer via USB and has software is $455. And there are none on ebay.

If I got it, I could try to make up some of the price by renting it out to friends who are concerned about apnea, and/or selling it on eBay when I'm done with it. It would also be fun to check out Shannon & Tovar's sleep, both of them are somewhat heavy sleep breathers and I don't think they have apnea but it would be good/fun to check.

Anyway, on the one hand that seems pretty damn expensive for something I'll probably just use for a few weeks. On the other hand, if it helps me make the big decision about jaw surgery, which could potentially cost me anywhere from nothing to $80K, that could be really valuable. On the gripping hand, I'm pretty sure I'm going to go ahead w/ the jaw surgery, this is more just to reassure myself about it. On the even more fictional fourth hand, it would be nice to monitor my recovery from the jaw surgery and compare saturation numbers before and after, and do so on a regular (weekly or nightly) basis rather than a single follow-up sleep study.

Thoughts?

Ooh, here it is for $299.

One-topic mind tonight...understandably...

I believe I have other sleep problems besides my airway size, as several commenters have mentioned might be the case (dlakelan, nasu_dengaku and others). My belief & experience so far is that airway size is fundamental enough that I can't work on other stuff until it is fixed. But I do expect and plan to work on other stuff (and need to do so) once my airway is fixed. I think a Quantified Self-style randomized intervention / track lots of variables experiment would be much more valuable at that point, because "home interventions" might actually work.

Anyway, this MMA patient experience is a good example of this idea:

So, here it is 8 weeks after surgery. Besides the recent surprise detour and lost week, I feel like I'm on the mend, and might have found a critical piece of my sleep puzzle - Spray paint sensitivity. Without a doubt, MMA fixed my main breathing problem (tongue collapse), but it looks like I've underestimated the affect of allergies (mainly thick drainage) on my sleep and will begin working on that.
...
6 Month Sleep Study: My sleep is SOOOO much better, but not perfect. I'd say I'm 70%+ better. I can certainly live this way but would like to be even better. Before the surgery, I could not live that way any more. Now I have very small events in certain positions and when my airway is inflammed due to allergies or paint, sawdust, whatever. They are just enough to wake me, but taking an Ambien lets me sleep fine and I feel rested most days.
...
It's been 17 months since my MMA surgery...On Oct 17th, 2006, I went back and had Dr Powell do some soft-tissue work including a modified UPPP (leaving the tonsils), RF to the turbinates, and RF to the base of the tongue...I would estimate that this final surgery has improved my progress from 70% post MMA, to 90%. My sleep is the best it's been since these problems started in 2001. There are other surgical options, including hyoid suspension, but at this point my sleep is good enough that I'm not considering it.

That's the sort of improvement I am expecting - say 50% - 80% initial improvement, and then tinkering w/ behavioral changes to fill in some of the gap.

Cost: Insurance may pay for some or all of the surgery. Also, I have seen figures as low as $30K. So the EV of the cost is significantly lower than $80K at this point.

Ad-hoc treatments: Quite a number of people, in response to this and other apnea posts over the past year, have commented/emailed with suggestions for apnea home remedies - ad hoc DIY treatments to increase sleep. I am deeply grateful for the caring that impels so many of you to research the topic and make these suggestions. Y'all are awesome! However, they suggest to me that I have not adequately conveyed the scope of the problem and my history of trying to deal with it.

I have had sleep problems for about 10 years, and been seeking professional help for 8 of them. I have talked to world-renowned doctors (Dr. Li, my apnea surgeon, and Dr. Triadafilopolous, my reflux surgeon, are both people with dozens of papers, active clinical practices, and who are a wealth of knowledge and a joy to talk to), read and researched the subject of sleep disorders extensively, read half a dozen books, and generated many hypothesis about my problems. I have tried dozens of these ad hoc, minor interventions [1] without success. I have also tried a number of medium-sized interventions [2], without success.

I am considering a major intervention because at this point, I believe that it is extraordinarily unlikely that any additional ad hoc intervention will help.

Sleep is very complex, and it can go wrong in lots of ways. Mine has multiple problems, and if my apnea is cured, I expect others to materialize. But the conclusion I have groggily come to is that having a patent airway is a necessary condition for good sleep, and minor interventions are not enough to fix my airway. A patent airway is so foundational that working on other aspects of my sleep problems is completely useless until I can fix my airway. (For those of you with first aid training, apnea can be considered a failure in the "A" of a first responder's "ABC", Airway, Breathing, and Circulation. Yes, it's a minor, transitory failure...but in one of the most fundamental parts of the body. Think of it as a "minor, transitory" carotid artery leak, if that makes a more striking mental picture).

I'm open to arguments about why this reasoning might be wrong. I think I may well be stupid not to want to get a second opinion about other moderate options like GGA, or to be pursuing them before MMA, due to an illogical desire to have this just be fixed and over. But I am pretty sure that anything less than GGA is just not going to help me at this point.

So while I'm grateful for the desire to help me, I don't think suggesting minor interventions is very helpful right now. An MMA surgeon in India or Thailand w/ significant experience who can save me some tens of $K over Stanford, now that would be useful :).

[1] Exercise, breathe-rite strips, sleeping on my stomach, special mattresses, special pillows, hot baths, rigid schedule, a dozen different sleeping pills, herbs, extra light in the morning, extra dark at night, relax before bed, and lots lots more.

[2] Septoplasty, turbinate reduction, tonsillectomy/adenoidectomy, dental appliance (twice), GERD drugs/surgery, CPAP, didgeridoo.

Emailing w/ someone who has had apnea surgeries, he said: "I've been taking (a sleeping pill) for a while to help me not notice how badly I'm sleeping."

Oh man, that line resonates with me so well! Sleeping pills are totally all about knocking me out so I don't notice how badly I'm sleeping, and at least get a lot of unconscious time, even though it is bad sleep and I feel just as tired afterwards.

Other thoughts: I think something like 1/3 of my productive hours in the past 4 years have come directly from provigil and/or caffeine.

Also, google tells me that stage 3 sleep should be 12-18% (mine was 7%), stage 4 about 10% (mine was 2.5%), and REM should be 20-25% (mine was 15%). Stage 3 & 4 are the stages that provide deep physical restoration, and are most easily disrupted, so my low rates of time there meshes with my poor perceived sleep quality.

Sleep study results: RDI of 10.6, about the same as before, I think. Lowest sat improved to 92% (was 89%), from baseline of 95%. 15% of time in REM, 2.5% in stage 4, 7.0% stage 3, 74% stage 2 (50%-65% is normal), 2% stage 1. (Sleep stages)

Dr says that less invasive surgeries such as GGA can work, but it works less than 50/50, you can't predict when it will work, and it sometimes relapses, whereas MMA works ~90%. He is willing to try one of the smaller ones if I want.

He says that insurance may not cover surgery, given that my numbers are mild apnea. On the other hand, he said the numbers only roughly correlate with subjective sleep quality, ppl can have high RDI and feel ok ("I'm just here because my wife says I snore a lot"), others like me have low RDI and feel awful. Without insurance, it might cost as much as $80K. It would be worth that much for great sleep, but then I start to worry that I have other sleep problems besides apnea, and recall them, and worry that I might still have bad sleep after the surgery.

He said the dental appliance is starting to mess with my bite. He is taking an xray to look at my jaw & airway. He said he tends to recommend surgery and more aggressive surgery (like MMA) to young people like me, as apnea takes a big health toll over the years. But it is a "huge decision" I should think over. He will put me in touch with a patient to talk to who is like me, young, fit, mild apnea but low sleep quality, who got the surgery.

I guess I feel like I've made the decision already. Poor sleep is by far the biggest problem in my life. While there may be other contributors, the fact that my sleep study shows some apnea and that subjectively I notice waking up suddenly with my heart pounding, and that I feel worse when that happens more, seems to indicate that apnea is at least some of the problem, perhaps a major part. The surgery may be pretty major (hours of anaesthesia, a few months of recovery), but it is very effective. And the impact of apnea on my life is huge enough to make "$80K and several months of recovery" look small. The extra energy from good sleep could easily produce that much money and time in a few years.

Or to put it another way: I had 1/4 provigil this morning, and a half cup of coffee, and I was yawning in his office at 11am (today is one of the rare times that I feel tired even after taking provigil). I had 8.5 hours of sleep, and I feel like crap. This for someone who used to literally bounce off the walls and hop up and down with energy (and still does, on rare occasions when I get a couple good nights of sleep). That's fucked up, and I think I should leap at the chance to do something about it. I am lucky enough to have a flexible job and enough savings that, while $80K hurts, it is manageable.

Guess I won't take my acrobatics class this quarter...I was already going to miss 2-3 out of 12 sessions from travel, this would knock off a few more.

Been rewatching Firefly lately. Damn good show. I like TV. It turns the brain off.

Just discovered Steve Brust's Firefly novel. Shiny.

I keep thinking of things to post and/or comment on y'alls posts, but either I'm out and don't feel like dealin' with the slow keyboard of the gphone (better than iphone but still a bit slow), or I'm in and don't feel like writin' up all my thoughts. Been focused on work and relaxing lately, not much time for aught else. Less LJ posting/commenting is a good thing, for sure.

I'm super psyched to have ipsafictura and jhogan working at TSI, ipsafictura has hit the ground running, and we're wooing jhogan to increase his time with us. We may even get an office soon! We are spending money a bit faster than I'd like, but I know we're going to get tons of awesome stuff done in 2009. (Patented & open-sourced big seastead design[1], StudioStead in the water or at least in progress, Ephemerisle in the Bay, a substantially bigger conference, tons of publicity, and massive growth in members/volunteers/exposure).

Had a couple nights of good sleep earlier in the week, after weeks of medium to bad. Was quite nice. I did things like jumping up and down repeatedly and making happy noises. Like, for an awkwardly long period of time - at least 30 seconds. Reminded me of college. But the good sleep didn't last. Thank science for provigil.

I'm psyched to learn that the big NLH game in Palm Springs goes Fridays and Saturdays. We're going to LA Tuesday, and then Palm Springs Wed through Sunday morning to visit Shannon's parents, and I'd been bummed that there didn't seem to be a good way to work poker into that (LA being the poker capital of the world, along with Vegas). Be a long way from Palm Springs to the Commerce. And stopping there on the way to or from wouldn't really work for Shannon, as she doesn't want to hang out in LA w/ Tovar.

Anyway, I knew there was a once/week big game ($10-$20 NLH, but I hear it plays bigger) in Palm Springs, but had heard it was Tuesdays. I called the casino today and it's Friday/Saturday, so perfect! I can get in 2 nights of play during our vacation in what I hear is a juicy game. Fabulous! (Yes, I am a degenerate :) ).

(Also, for the first time in my life, now that I'm a) in the non-profit sector, b) running good, c) playing good (and exercising game selection), my gambling results are not only positive but a material portion of my income. We'll see if it lasts.)

We are still working on an outsourced Panama pregnancy. Planning to get an au pair / live in nanny for the next kid, because, well, that's how we roll. I can see how some ppl think it's weird that I really want more kids, yet really don't want to spend more time with them. I dream of having apnea surgery and sleeping great and having energy all the time, but I dream of spending that energy on seasteading, not on kids. A couple hours a day is bliss, more than that quickly degenerates into torture - especially without my laptop! But...I really like those couple hours, and being a parent, and my experience has been that it doesn't take a huge amount of time to have a strong relationship w/ Tovar. And I think he's much happier to exist than to not exist. So it seems like a win for everyone. If there is resentment down the road...we'll deal with it.

Err...that's all that comes to mind. Our schedule for Q1 2009 is still very uncertain, as there may/may not be a Panama trip / Apnea surgery in there. But it is likely to be very busy if 1 or both of those things happen.

Happy Holidays to all!

p.s. I am listening to Tovar sing "I'm a little teapot, short and stout" to himself on the baby monitor. Singing himself to sleep...so cute. Earlier to day, after we changed his diaper, he started singing "Skip, skip, skip to m' poo!" Improvising song lyrics with potty humor...that's my family!

p.p.s. Oh, and I'm running for the board of Humanity+ in January, and may be doing some outreach / community building initiatives with them next year. I never thought that my interest in community-building would be a valuable work skill, but it's looking increasingly important.

[1] The consultants jokingly asked if I wanted the report to include input files for the hydrodynamic modeling software, and I was like "Yes, definitely! That's on my list.", and they were surprised/amused :). Hey, we're a geeky nonprofit, we're all about publicizing even things so technical that hardly anyone in the audience will have the software to use them! Because, hey, if someone does have WAMIT...that's someone who we want to get involved!