Categories
Medical

Day 845 and Fucked Fertility

A bit of discourse stirred up a lot of grief and sadness for me. Noah Smith did an analysis of the much discussed Atlantic piece “The Myth of the Broke Millennial.” His breakdown is excellent and I recommend the Twitter thread where several of my geriatric millennial friends weigh in on how late in life security has come for many of us and how precarious it still feels.

What jumped out at me most in Noah’s breakdown is whether millennials will feel financially secure enough to have kids if it’s indeed true that we are getting less precarious.

That matters as a question as having children appears to be a driving force towards conservative politics but also a general preference for less government involvement. Noah wondered if millennials will be less woke and less inclined to socialism if we don’t turn out to be downwardly mobile. The theory is we might be if, and it’s a big if, we feel secure enough to have children.

There is one age-related factor that appears to draw people to the right, however: having children. Fertility rates are down, and Twenge discusses some reasons for this in her article. But what really matters for politics is probably not the number of kids that get born, but the number of people who end up having any kids at all.

I’ve got bad news on this front as the first wave of elder millennials who haven’t already had kids probably can’t. Why? Our women are aging out of fertility before they find the security they feel they need to consider having kids.

By the time millennial women get to a place where it seems feasible we’ve long entered “geriatric pregnancy” territory. I froze my eggs right before it was considered a geriatric situation. Which is give or take 31-32 now as we redefine fertility. I am now 39.

Now that’s a longer story for me personally as freezing my eggs felt like a consumer decision, was marketed as insurance policy, and ended up being a life changing catastrophe. And I still don’t have kids.

The process of egg extraction triggered an inflammatory disease and I may never be able to carry to term. And I have complicated grief stricken emotions about the entire affair. And we spent a small fortune getting me healthy enough to go back work.

But my suspicion is that many millennials will learn that fertility isn’t as easy as they imagine if they try to deal with it past 35 let alone past 40.

And we simply cannot seem to discuss the issue in a way that is productive. The discourse is toxic as cultural warriors, often men weigh in with their complex emotions about what it means to have a family, support children and generally deal with women’s health.

Shaming and controlling women’s bodies doesn’t really do much for the cold hard reality that we failed many millennial women by assuring technology could solve for the hard questions on fertility. So we marketed these new medical options and sold it at premium. Silicon Valley mounted a whole campaign to freeze eggs for its female workforce.

I’m afraid we are too deeply entrenched in a culture war to discus this productively as most of the people I see with the message that fertility is complex tend to view things in a more traditional context.

I personally love playing a tradwife on Twitter because I’ve learned a lot about how reactionary feminists and baroque online misogyny views motherhood. They talk to me and I’ve listened.

But we need to get women of all politics and preferences and family structures involved in this conversation as a full decade of millennial women are going to need to consider their relationship to their own fertility and bodies in short order. And for many of us it’s too late.

Treatments like IVF and egg freezing & extraction are expensive and have considerably more risk than we are comfortable discussing. Surrogates are a quarter of a million dollar expense which disgustingly is for bureaucratic costs not the surrogate herself. If you want multiple children it’s not crazy to plan for a million dollars. And don’t get me started on how adoption plays into all of this.

A generation of fucked fertility with myriad corporate profit motives driving decision making sounds like the stuff of conspiracy and cranks but don’t be fooled by extremism. We’ve done a shitty job investing in women’s healthcare in America and it will have consequences.

I know it’s scary to look at head on. I regularly break down with my own grief on the matter. I’ve been looking at it for years. Having a serious health crisis brought on by family planning has been a blessing to my marriage but that blessing has enormous costs. I’d expect this process of addressing the fertility of a generation of women to be challenging for us all no matter your personal choices or politics.

Categories
Community Homesteading

Day 839 and Chatty

I occasionally have the ambition to be less of chatty Cathy. I almost cannot help myself in Montana. I keep meeting folks who are into the same stuff as me and then I’ll just end up talking for an hour.

Introverted Julie somehow always finds the homesteader, science fiction, alternative economy, crypto libertarian aesthetic studies semiotics pirate at the party. Sometimes it’s even the same person (hi Frank). I’ve now found not one but two homestead curious folks at a spa. The same spa! (Hi Kylie & Lorraine!)

I’ve got a general philosophy in life that you should be a beacon. We are responsible for our light and maintaining it. But are we not equally responsible for shining it into the darkness?

I’d like to see my broadcasting into the abyss of the internet as being a sort of existential lighthouse. Perhaps my chatty nature is some form of the same ambition. I want my people to find me.

And wouldn’t you know it but I’m always finding people searching for the same things. I have so many pockets of knowledge. And I want to share what I know with you. I want you to share your knowledge with me too. Your world and your experiences will add to mine just as mine adds to yours. Like the Borg but decentralized.

I’ve got a lot of weirdly specific knowledge. You know, Julie Fredrickson shit. And I want the folks who need the light I’ve cultivated to find me. So I will broadcast.

I know how to be in my body even with illness. I know about inflammation and healing from post viral shit. I know about sovereignty and survival and independence. I know a thing or two about being a doomer and an optimist.

I’ve got weirder more specifics knowledge too. Ask me about corporate governance structures and decentralized autonomous organization. Or the most cost effective luxury unbranded retinols. Or what biometrics to track and on what devices.

The point is that I’m here to be a chatty Cathy. And if you’d like to talk just slide into my DMs on Twitter. Or email me. It’s my first name dot last name at gmail. Consider this your bat signal.

Categories
Medical

Day 836 and Medical Care & AI

I had a little bit of excitement in New York City when I encountered some type of gastrointestinal issue. We’d speculated it was food poisoning or norovirus with our doctor.

After getting it out of my system and speeding back to Montana; we’ve been pouring over the symptoms, timing, biometrics and medicines to see if we missed anything. It felt like an opportunity.

We had three doctors retire on us this year and after two years of rising premiums, we are naturally skittish about health care. Pandemic telehealth reimbursement being sunset is a hit to rural care as is the other policy roll backs as the of emergency winds down. Reciprocal licensing across all states sure seemed like it should have been a keeper. But alas American health care is a mess.

Thankfully we’ve got a doctor local to us in Montana who we’ve been slowly building up a relationship with over our first year here. After his star turn in this gastrointestinal saga, I am ready for a round of blood work and a look at the big picture with him.

We’ve even been dabbling in a few theories with our Large Language Model friends. While ChatGPT goes to a lot of trouble not to diagnose, we’ve been able to run down some leads on our own and bounce them off our doctor. I’m looking forward to getting a look at my liver panels and gallbladder. Maybe tweaking some of the pharmaceutical line up.

While it may seem a bit grim, I’m considering that with enough questions asked and enough clever inferences on our behalf from our new AI friends, maybe we can get further. Sure we are down 3 doctors and up 30% cost wise, but maybe these plucky kids can make do with a chatbot, a young doctor and a can do attitude.

Categories
Medical

Day 834 and Inside Out

I had a really rough night last night. It’s entirely possible my original theory of industrial lettuce wasn’t the whole picture.

For a little timeline clarification. Yesterday, I woke up with stomach troubles after eating agribusiness salad chain for dinner on Wednesday. I had meetings on Thursday so I took some varied drug store tummy medicines and gutted it out. I even had a very fun time at my meetings. But then as the adrenaline of the day wained I was heading towards disaster. The nausea and had was getting worse.

I realized I couldn’t attended a dinner with some old friends but Alex was fine. I told him to pick up some Tums on the way home. As his dinner wore on my symptoms got worse and worse.

I felt like I was beach ball ready to pop. My stomach was distended so far I felt like I had back problems my stomach pushed out so far. I was tight Mike a drum. The pain and nausea consumed my focus. Around 7:30 or so I called Alex saying I needed a doctor or a visit to urgent care. I couldn’t tolerate it any longer.

Blessedly our doctor in Montana called back almost immediately. He had just personally had a case of stomach flu or norovirus himself and mentioned it was trending up nationwide. At that point I was mostly moaning and curled into a ball from the nausea and gas. He prescribed an antispasmodic called dicyclomine. It helps calm stomach cramping.

I had an hour of crying and praying waiting for it to kick in. I’m sure I scared the shit out of the other hotel guests with the moaning and crying. I was begging Alex to please fix it. To find something else I could take. To do literally anything to relieve me of this horror. Thankfully around 930pm or so it kicked in fully. How do I know?

I was able to vomit. A lot. Seven times over the course of half an hour. And then I was fine. My stomach deflated down to a normal size. The nausea abated. The pain and cramping subsided. Four hours of intense misery has passed with a drug that turned me inside out.

I spent all of Friday in bed sleeping it off. I missed all my meetings and couldn’t eat anything till dinner time came around. I’m having some soup and I suspect I’ll simply pass out. New York is an inside out kind of place sometimes and I’ll just have to live with it.

Categories
Medical Travel

Day 833 and Industrial Romaine

I packed my day a little too full so I found myself ordering a salad from popular New York industrial salad chain Chopt at 8pm right as they closed.

The order was placed on an app so it was a crapshoot and I knew it. And sure enough I got something that wasn’t what I ordered but I’d been running around for 12 straight hours so I just said fuck it I’ll eat this weird burrito of industrial romaine and mayonnaise because I’d really rather be passed out.

Incredibly poor decision making on my part. I was up early and I was up often performing ablutions and praying to the gods of intestinal fortitude that this please pass swiftly.

I appear to have stopped with the worst of it and had about an hour or so before a meeting I really didn’t want to cancel. It’s not as if food poisoning is catching. So I groomed and put on something that would withstand the 88 degree heat of…checks notes… early April in Manhattan? And then I got on the subway.

Shockingly heat and the subway aren’t a great combination, but I was determined to gut it out. I’d left early so I could find my way to a drug store. Naturally nothing was available to purchase without someone unlocking a cabinet. Nothing more humiliating than asking if one could have a key to acquire GasEx, Tums and Imodium. A really stellar look all around.

I’m now comfortably in a lovely office of a venture capitalist hoping it all kicks in before I need to attempt socializing. Naturally I’m taking the time to write about it as I wait as it’s keeping my mind off the discomfort and misery of it all.

This isn’t the first run in I’ve had with agribusiness greens that’s gone awry for me. Many moons ago I got food poisoning from spinach I bought at a Trader Joe’s. A few blocks from where I am now. I had Gucci insurance (literally Gucci the luxury house I do not mean that it was particularly fancy) and spent the night in the emergency room. So maybe this is just a full circle experience. Ashes to ashes romaine lettuce to romaine lettuce to romaine lettuce.

I can feel the drugs kicking in and maybe I’m at the end of it. And hopefully this will just be an amusing anecdote that I recount on why we need to be more careful with food safety and industrial run off. But also I am loathe to cancel a commitment during a business trip. Showing up matters too.

Categories
Chronic Disease Travel

Day 791 and Bathing Suits I’ve Never Worn

I’m on maybe my third or fourth trip to a warmer climate where I’ve brought a Norma Kamali bathing suit. I bought it on sale from Net-Porter as I’d always wanted one of her classic one pieces. I’ve never worn it.

For the casual reader, I have a chronic autoimmune disease called ankylosing spondylitis. It’s an inflammation condition that affects my spine and is aggravated by heat & humidity. Any temperature above above room temperature, give or take 72 depending on the humidity, starts to swell my tissues.

It’s well controlled with drugs but environmental factors can quickly spin up a bevy of symptoms including pain so debilitating I can’t walk. It’s one of the reasons we moved to Montana. I can live a semi-normal life so long as it’s cold. I spend most of my days laying flat in bed or in a zero gravity chair. My disability has become one of the super powers I use to propel my investing alpha. Because what else do you do with your time if you can’t leave bed except monitor financial indicators and chat with founders?

But back to the bathing suit. The black halter swimsuit has turned out to be entirely an aspirational garment. It’s still got the sanitary sticker for the crotch on it that says remove before wearing. I left it in and it’s become the not so subtle reminder that I may never enjoy a beach vacation again. It’s simply beyond my grasp unless I want to pay an obscenely high cost in pain and immobility.

I dutifully pack the Norma Kamali suit on each trip with a warmer climate. I’ve taken it to Miami, Texas, the Mediterranean and Mexico now. For this trip to Puerto Vallarta I packed a second bathing suit. It’s a striped bikini.

I had a fantasy that maybe I’d need a second swim suit as the other would need to dry if I swam every day. Oh what self deception we humans are capable of when it involves something we cannot have but want. I’ve never put the second suit on either. It also has the sanitary sticker still on it. It’s beginning to feel like they taunt me. Isn’t it funny that Julie still yearns to participate in the simple pleasures of life. “That dumb cunt” I imagine them murmuring as I pack.

My father loves tropical vacations. An adults only resort on a beach is his idea of a good time. And for his birthday, my brother and I very much wanted to give him what he wanted. Part of this is self protection as he often forgets to ask after other people’s preferences even if they are for something serious like a disease or disability. Better to avoid disappointment than know for sure. But also if we can give him what he wants why not make the sacrifice? It’s expensive for me energetically but I wanted to spend.

But it’s become clear I can’t make the sacrifices desired for the perfect fantasy family vacation. The bathing suit gets tossed in the suitcase with the knowledge that I can only manage one event outside each day. It’s usually a dinner or a chat.

Then I must sleep it off and work to recover. There is no space for pleasant relaxation on the beach in my body. The compressed Lycra slowly battling the expansion of my tissues as they swell overlapping with stuck lymphatic liquids would be torture. There is no joy to be found and no extra capacity to be eked out that might make the experience mimic the pleasure in a healthy body.

The fantasy is just that. A delusion I have about a life a lost and unlikely to be regained. The after effects of fertility treatments, IVF and living hard to outrun the vicissitudes of capitalism. I’ve accepted it as my lot in life. But it’s much harder to get it across to the rest of the world. And my fear that I’ll be left out and forgotten, that if I don’t fit myself into someone else’s life I’ll be abandoned. And so I rationalize that I’d be abandoned if I don’t at least try to bring the bathing suit. Even though going to the beach is a fantasy.

I hope my friends and family are able to meet me half way but I remain afraid that they don’t know how, or are unable to imagine what it’s like to live in my body. And it would be nice to be met halfway.

Categories
Biohacking Chronic Disease

Day 790 and Siesta

I have been crashing out of my day into a sleep cycle after lunch till about 4pm while I’m in Mexico. The stress of the situation along with the heat and humidity have me needing a lot of rest.

Last time I was in a hotter climate I’d find myself crashing out into naps if I did something like eat lunch outside. I think something similar happened here. There are no air conditioned common spaces in this hotel so if I want to spend time with someone I’m outside. Sure there is shade but that doesn’t knock down anything but brightness. The heat and humidity strike anyways.

I hate this phenomenon. I don’t find it helpful to be laid flat and exhausted by two or three hours outdoors, sitting, in the shade; but it’s absolutely draining. Even if I felt like I had a full charge, which I don’t particularly, I’d be down in the red quickly.

I woke up with someone asking about dinner plans which I had offered but in truth the most I want to do is get some dinner and go back to sleep. It’s just much too draining to be outside and there aren’t many restaurants in this town with air conditioning.

Categories
Biohacking Chronic Disease Travel

Day 789 and Types of Poverty

As you’ve probably seen articulated in thought leader tweet streams and thot-leader Medium posts, there are different kinds of millionaires. If you are young you are a time millionaire. If you are able bodied and healthy you are an energy millionaire.

I am in energy poverty. I carefully ration my attention & time and use lots of time-economic craft like asynchronous communication like emails and direct messages. Like a thrifty person with a budget I am always cutting the various coupons of time in my life to cobble together enough time to work full time so that no one can tell I’m energy poor.

It’s pretty common for folks to be in energy poverty. Maybe you are a parent. Maybe you are a care giver for an elderly parent. Maybe both. The most common is of course being disabled and requiring care. I am in that category.

I’ve turned my energy poverty into my super power. I am like Mr World monitoring feeds across the globe laying back and ingesting information & taking small minute actions to adjust my plans. I’ve adjust my career to fit this reality and find it to be an excellent fit for investing as it’s all about finding the alpha and acting on it.

I do telegraph that I’m in this situation. That my mind is sharp but my body is weak. I accept 2-3 events a week at maximum that require me to be up, about, in makeup and battle regalia (business dress) and the rest is dedicated to recovering.

I’ve never had hobbies that couldn’t be done from bed. The last time I participated in a sport was in my twenties before my latest flare. I’ve not had a social life independent from work for decades. It’s isolating and I remain perpetually afraid of losing people who aren’t in the same situation of energy poverty as I am.

Capacity can be drained further by negative conditions like heat, humidity or bright light. I am the type of disabled person that finds showering to be a huge drain so typically include those in my energy budgets as drains. Travel requires 24-48 hours of minimum recovery time which is why I tend only do month long stays places. You may have noticed I go cold places like Prague or Frankfurt and I live in Montana. That’s based on doctor recommendations.

Certain types of travel can’t be done without significant outlays of energy budget that will leave me in deficit for weeks. Beach vacations have long ago been lost but I can manage a tropical location so long as I stay entirely inside in an air conditioned room. Don’t worry laying on the beach isn’t fun for me so I’m not missing anything. Heat & salt water humidity is the fastest way for my body to begin an inflammation cycle.

I’m in Puerto Vallarta for my father’s birthday and the best I can manage is stay in my room all day and a dinner every other night. It’s a little confusing for folks who aren’t in energy poverty to fully grasp the concept but I feel no more frustrated with my situation than I would if I had financial poverty. Sometimes it’s just the situation and your budgets have hard limits. I’ll make an effort and spend 2 weeks of an energy on a long weekend for someone I love but it does cost me. Everything costs something.

Categories
Chronic Disease Travel

Day 786 and Snow Birds

I woke up at 5am this morning to begin my journey from Bozeman to Puerto Vallarta. My father’s 80th birthday celebration is taking place in the appropriately warm tropical conditions so favored by retired snow birds. And it’s his party so he gets to chose his favorite location for us to gather to celebrate him.

Both my father and I live in Montana, but he tends to prefer travel more than me by a wide margin. I travel mostly for work and family obligations. I don’t find travel to be fun or an enjoyable luxury. Vacations aren’t my thing. Especially when it involves travel to somewhere hot. I would have been happy to celebrate in the -20 in Glacier personally.

Most of dislike of travel comes down to not caring for hot weather because of how much it hurts my body. It makes my spine swell. Humidity and heat are my enemy. I live in Montana partially for health reasons as anything above about 75 kicks in some of my inflammation issues.

Add in the additional strain on the spine of sitting in uncomfortable seats for hours and I’m currently struggling mightily not to wail uncontrollably from the pain. I desperately want to lay flat to ease some of the tension that has built up from needing to hold my body still and upright in uncomfortable airplane seats. I don’t want anyone to see that I’m barely holding back tears because the pain is so bad.

Alex got tisked by the flight attendant for trying to retrieve some of medication as we’ve got one of those useless bulkhead seats. It’s a terrible choice for even a modest disability as all the things that keep me functional in my travel bag were immediately whisked into overhead compartments. We didn’t do it fast enough and the attendant hovered asking that we hurry it up.

I haven’t done short haul flights in a while as most of my travel has been flat lay seats on international overnights. I wasn’t prepared for how much sitting up in a tight domestic airline seat would hurt. All I want to do is lay flat on a bed for 24 hours after this.

I’m on an airplane packed to the gills with Lily Pulitzer knock off wearing Boomer blondes and their salmon shirt wearing deeply tanned husbands. They all seem cheerful and excited to be headed to Mexico. Snowbirds are a colorful species. An exotic and hopefully endangered species that will eventually give way to more local and regional appreciation as the next generation of travelers pursues less Jimmy Buffet stylings.

Categories
Medical Politics

Day 776 and Informed Consent

I’d really like to write about informed consent and whether it is a convenient fallacy to obfuscate the harsh reality that medicine isn’t as black and white as we have been led to believe.

It’s a complex topic so consider this my notebook of scraps and gently judge it’s content as it’s not a full cohesive argument so much as a collection of thoughts I’m working through here. If you feel you are reacting to it strongly please work through why on your own time.

I am on this topic as I am reaching a point of frustration with the discourse around transgender issues and who is responsible for informed consent. We’ve got a spiraling culture war where everyone is ignoring basic facts like children are below the age of consent and thus their parents are responsible.

Our entire legal system is based on the premise that before 18 you have not reached the age of reason and are not fully responsible for your actions. Yes it’s flawed and doesn’t always work that way and we try minors all the time but the fact remains parents are the guardians of their children.

I am oddly both well read and well cited on issues related to informed consent and substituted judgement as I was a medical ethics research assistant at the University of Chicago. I got paid $10 an hour for my troubles so you know my credentials check out (in sarcasm font). Seriously go look I’m an author on a few papers.

Making a choice to engage in almost any medical procedure is risky in ways no one, not even doctors, can fully articulate. Bodies are complicated and abiding by a simple principle like “first do no harm” turns out to be hard calculus.

Sure you can get awfully close to the right answer but you will be pretty far down the calculating differential equations path once it dawns on you that we can get infinitely close to certainty but certainly itself cannot be reached. Turns out math is useful in daily life.

Patients have a right to chose their own risk parameters. Doctors do their best to inform. But the grey area is so wide it’s practically an abyss. Add in making decisions for a minor and it’s all best guesses and other people’s facts. Believe the science means you’ve got to do your own math and it appears most people are innumerate.

I am willing to make big criticism of the transgender panic crowd because they’d prefer to pick and chose convenient narratives like “think of the children” as a defense. I’ve heard that tune before in every other moral panic. And yet it’s still not the government’s job or the doctors job to make the call. It is the parent’s call because children require the substituted judgement of their parents for informed consent.

If this is annoying or unsatisfying to you well that’s a bummer for you. I’d encourage you to read up on how we’ve scapegoated populations in the past to make sure the in-group’s priorities and social mores are sustained. Every moral panic has one. I’d recommend René Girard’s work here.

When we fixate on a vulnerable population the story is always the same. And I believe anyone who is reading this blog is smart enough to grasp that in good faith. And we’ve got a long history of scapegoating people who don’t conform to our majority population’s comforts.

The transgender issue is no different and trying to wedge it into a “but the children” argument runs up against two issues. Most of our American historical moral panics have scapegoated in this exact way. And medicine is simply not so concrete that any treatment for any condition is risk free.