Tuesday, December 13, 2016

Three years? Time flies

It's been three years since my last colonoscopy, and three years since my last post. Reading that post feels like reading a note in a time capsule; so much has changed since then. My wife and I bought and fixed up a house, had a baby, both had work changes (she moved schools, I got promoted) and have had some wonderful and trying times. Stress out the wazoo.

But one thing hasn't changed: I'm still symptom free. More on that in a bit.

Diet-wise the only hard rule left is "no gluten", which in pragmatic terms translates into "no regular, large starch piles". However, I do eat potatoes with regularity, and have ventured into the dark lands of gluten free pizza a few times (with predictable results). Overall, my diet remains centered around meat, eggs and cheese, with fruit (mostly "gross" bananas), vegetables and starchy tubers rounding it out.

One negative health event was scoring high cholesterol for a physical two years ago. 290 total, I forget the exact splits. At the time, I was chugging milk and yogurt, so I stopped. A year later I was down to 204 and had an extremely positive Boston Heart panel. High HDL, the right LDL pattern, etc. The cardiologist was a little stunned by the turnaround and mentioned that it takes most people years to pull that off. Most people probably aren't drinking that much milk. I guess my phenotype doesn't respond well to a sustained dairy onslaught. Oh well. I've been making up the calories with a shake made from protein powder, super-ripe bananas and peanut butter, with no negative side effects.

On to the colonoscopy.

I switched gastros to one who had a facility a little closer to my new house. The prep they gave me was astonishingly inoffensive (suprep). I recall gagging and being almost unable to finish a similar prep (fleet phosphosoda or something like that), but this one was so mild it was no big deal. Only complaint about the procedure itself was that instead of giving me the relaxant a few minutes ahead of time, they just knocked me out - come on guys, I crapped my brains out for twelve hours, I think I deserve a little legal high time.

Woke up and the doctor told me everything looked fine. No polyps, no inflammation, no visual signs of disease. Come back in two weeks for follow up.

When I went to my follow up appointment, he said that I didn't look like I had Crohn's. He had me go through my history just to make sure that my diagnosis seemed sound, and I don't think there's any doubt that I do in fact have the disease. He said that it's so thoroughly in remission it's hard to tell. All of my biopsies were unremarkable except one which showed some signs of old inflammation, which wouldn't be enough to diagnose the disease if I was a brand new patient.

He grilled me about my diet for a bit and said that he's seen a few people like me, all with their own random diet stories. It's not possible to say if I actually induced remission with my year on meat, or just had a random remission start at the same time, but he said that given the individual nature of the disease and our lack of understanding of the microbiome, anything's possible. Maybe in ten or twenty years, we'll be able to sample your gut and say, "Eat like this and you'll be fine." The science just isn't there yet.

He said that given my results I probably shouldn't bother coming in for another colonoscopy unless I had symptoms, but he's obligated to recommend a follow up given that I have a history. Keep doing what I'm doing, and call him if anything changes, but otherwise my colon looks like any other 32 year old colon. Not bad.

So, maybe in another three years I'll go get scoped again. We'll see. For now, though, I'm fine.

Eight years ago I decided to eat nothing but meat for a year. Now I have a perfectly normal colon. If those two events are indeed correlated, and someone could figure out exactly how, a whole lot of people would be able to find relief from a terrible disease. I hope that in twenty years, I'll be able to shutter this blog with a post saying, "They figured it out, go eat X and Y." But for now, it's all up to you to find the diet that works best. My approach might not work for you, but I'm betting there is an approach that will. Don't give up!

Wednesday, August 28, 2013

August 2013 Update

My last colonoscopy was in 2011. The gastro thought things looked good enough to put off my next one for two years. Well, here we are in August 2013. Colonoscopy time.

First, a bit of a recap. For the past two years, my diet has gradually shifted from fairly strict meat and lactose-free milk with minimal vegetables to a more broad gluten-free, low-fiber heuristic. Nothing particular drove this change other than natural drift and complacency born of the fact that I was completely asymptomatic. Each change is small, each new re-addition tiny, but over time they add up, and soon you’re eating mashed potatoes on the side of your steak instead of another steak.

By July 2013, I was getting pretty lax. And again, it was hard not to be. I’d love to believe I have monk-like eternal dedication and discipline, but the reality is that I’m as human as they come. Give a human enough time in a situation, and they’ll adopt it as their new normal; my new normal was that I could eat a fairly broad array of things without obvious serious consequence.

So it was with that mindset that I went to Wales for ten days to visit my parents. While there, I think every meal was meat and potatoes. No complaints, either, as most meals were quite good to my taste. We hiked and bicycled and saw various historical buildings, and through it all I felt just fine. This was probably the most sustained starch assault I’d experienced since starting the diet, with no obvious consequences. I flew home a bit bemused.

I’d been experimenting with SCD yogurt for a month or two, just to see what the hubbub was all about. I’d created my own yogurt maker, which was fun and deserves its own blog post, and had made a bunch of successful batches. However, about a week after I got home from Wales, I made a batch that didn’t seem to turn out quite right. Instead of being smooth it was chunky and never really seemed to “set” into a creamy texture.

Being a stubborn ass, I ate a bunch of it anyway. Simultaneous to this, my wife made some chili. We have a running joke about chili: no matter how many times she cuts the ingredients, it always seems to come out so radioactive as to be inedible. This one was no exception, but again, a hungry stubborn ass eats what’s there, and I sweated my way through a decent sized bowl.

Needless to say, I spent my Thursday in communion with various toilets. If you’re reading this blog, you know what happened.

The next day we were driving to the beach to visit with my wife’s family. All through the drive, I felt an odd twinge in my lower right abdomen, almost like some little animal was taking quick bites inside my intestine. A bit disquieting but nothing to worry about; lower right side pain has been with me since my diagnosis and it doesn’t usually register consciously.

That night, I woke up nauseous and stumbled into the bathroom for an hour long session of “will I puke or poop”. Poop won (its victory lap was quite an affair), but the right side pain had stepped up its frequency. Now I was worried. I’d come across accounts of obstructions and strictures, and my experience roughly jived with what I’d read. There’s nothing quite like lying in bed, shaking slightly from insane diarrhea, legs and butt numb and full of pins and needles from too long on the toilet, wondering if you just dodge a bowel perforation.

Anyway, you know that lack of focus and clarity? It comes back with a vengeance after a night like that. Monk-mode, engaged.

From then until my colonoscopy yesterday, my only grudging detours from the Path of Meat were some hashbrowns on a hiking trip to Washington. During that time, my bowel quickly normalized, and the right side stabs started to subside. But they didn’t go away entirely, so I found myself actually looking forward to the colonoscopy. If there was a problem, they’d find it and that would be that.

The anesthesiologist said, “Good night!” as he gave me the sleepy juice. Believe it or not, that was a new one. Usually they just fire that stuff in and you’re out. See you on the other side, doc.

I woke up and did the usual massive groggy fart routine for about fifteen minutes. The nurse asked if I was on a special diet. I said I was. She said something like, keep up the good work. I gave her a thumbs up and she smiled and walked away. I’m guessing I wasn’t 100% all there yet.

Then the doctor walked over to hand me my results and have a quick chat. My gastro is very mild mannered and calm, so there’s not body language or facial expression much to read. But I imagined he seemed bemused or quizzical.

“So you’re still doing that Life without Bread thing?” he asked.

“Yep. Mostly meat diet, kind of low-residue.” I replied.

“Oh, low-residue as well? Steam all your vegetables?”


“Huh. Well, seems like it’s working. Everything looks fine.”

He shrugged and leaned on the gurney.

“Let’s say another colonoscopy in three years, office visit next year just to get some blood work. Sound good?”

“Sounds good.”

“Ok pfw, see you later.”

My WTF meter was off the charts. Keep in mind here I was expecting to be told that I had some sort of flare going on, although the pains had gone down to once a day by the time I went in. Instead, I had a completely clean bill of intestinal health. The report is boring as hell, just various bits of my colon and statements like, “Normal”.

And three years until my next colonoscopy.

Wow. I might forget how bad the prep is in that time.

So what does all this say? As always, I’m at a loss to explain it. N=1 is a horrible epistemic position to occupy. I don’t even know what I want to know anymore. I’ll retreat to some bare facts:

In AUG 2009, I started eating a meat-only diet. I crapped my brains out for three months until stabilizing in OCT 2009.

In NOV 2009, I stopped taking my medication.

In AUG 2010, I had a polyp removed from my intestine during my yearly colonoscopy and started drinking milk.

In Jan 2011, I started eating small amounts of potato starch.

In AUG 2011, I had a clean enough colonoscopy to warrant a two year gap until my next one.

Between that time and AUG 2013, I ate potatoes, ice cream, fresh vegetables, drank gallons of Lactaid (all on top of a diet of mostly meat, of course) without obvious negative consequence. I avoided gluten strictly, and while I didn’t count calories or carbs, I suspect that aside from heavy milk times I was still lower-carb than the general population.

In AUG 2013, I had another clean colonoscopy, warranting a three year gap until my next one.

I’d like to believe this is more than incredible coincidence. I’d like to believe that diet CAN influence the disease. It’s all quite suspicious, but I can’t prove any of its connected. And so I’m right back to where I was a few years ago: feeling fine, and wondering why.

Better than feeling like shit and knowing why. Here’s to three years until my next colonoscopy. I hope they’re as boring as the previous two!

Sunday, March 17, 2013

Interim Update

Just wanted to post a brief update since it's been over a year since the last one and a few people have asked how I'm doing. I'm supposed to get a colonoscopy for the summer, which I might do just for science, or I might not. If I do, that would be a logical blog update event.

But I might not, simply because I feel fine. I am completely asymptomatic. Why pay a thousand bucks to have a guy shove a tube up your butt to be told something you already know? At least with Crohn's there's no real "silent symptoms" - you're either flaring and you know it or you're not.

Some points about my diet and health state in no particular order:

My diet continues to be "meat-centric", but by no means is it "meat-only". My plate is beginning to look a lot more normal at a meal, but it still is completely absent any gluten containing product. For example, I recently ate a 1.5lb rib steak, which had on the side some mashed potatoes and a small pile of steamed spinach. No bread.

I've tried and survived eating ice cream and high-sugar treats. The consequence of over-indulgence is of course diarrhea, but I don't think that's a Crohn's symptom necessarily. That's just bombarding my body with something it's not used to eating. No lasting flare has followed this behavior.

As I said, symptom free. Normal stools most of the time. The timing of this post catches me in an odd spot, which is noted below, but in an overall sense I've got a drug-free remission going and I'm happy.

Recently, I decided to see if I could start running again. Periodically, the memory of past attempts to get in running shape dulls, and I wonder if this time is different. In the past, I've been able to run for a week or two, usually long enough to convince myself that this time is different, before the inevitable run where I have to find a spot in the woods to vent my entire body cavity, followed by a shaky walk home and the shower of shame.

This time it took about two weeks. I decided to ramp up as slowly as possible. I ran .5 miles to start. That's right - a half mile. Despite an utter lack of endurance training for years, I was barely breathing hard at the end. I then added a tenth of a mile per day. I always ran fasted - I don't eat breakfast usually - in an attempt to avoid jostling too much.

This past Wednesday, I ran 1.1 miles, went home from work, and barely made it to the bathroom. Note: taking your belt off while you urgently waddle through your front door is probably confusing or disturbing to your neighbors. 

On Friday I ran 1.25 miles as kind of a middle-finger to the whole situation, and haven't had any serious consequences. Maybe the 1.1 mile event was an outlier. But my father, who trained for and ran a marathon, also had to make sure to run on an empty stomach while training, and he doesn't have Crohn's. Maybe I'm just blessed with a weak stomach.

I'll probably keep this up until the next "event", and then bail back to strict weight lifting. I might not be able to eat enough to become genuinely strong, but at least struggling through some squats doesn't make me crack the toilet with a rectal shaped charge.

So there you have it. Meat still hasn't clogged my intestines, and I'm still alive. I'd still recommend giving the diet a shot to anyone who felt up to it, but I'd probably dial back the duration of strict meat only to "as long as it takes to normalize your bowel movements plus one to two months". A year is a nice number (lots of fun to shock people with), but it's probably excessive. 

Does it actually work? Hell if I know! This would be a heck of a coincidence if it didn't, but stranger things have happened.

Saturday, September 3, 2011

No Colitis

Hard to believe that it’s been over a year since I updated this blog, and two years since I started it. Where does the time go?

I’ll probably bump in here once a year or so with updates, just to make sure this information is current and honest. If at year three I have a massive flare up and die from meat clogging my intestines, it’d be a good idea to note that rather than let people believe this all worked out.

Of course, I have yet to have meat clog my intestines, and the title of this post is the summary from my latest colonoscopy: no colitis activity. Yay! Two years “cured”. My pipes looked good enough for the gastro to move me off of the once a year colonoscopy schedule – I go back in two years, August 2013. Awesome. This’ll be the first year I go without a colonoscopy since 2002.

What’s perhaps more interesting than the result is my behavior in the past year. I did not continue to eat only meat. Meat continues to form the basis of my diet; most meals are mostly meat. But I have added back in a pretty broad variety of other things. For the first few months post meat, I added back in some vegetables and drank a TON of Lactaid milk to gain weight. After a few months of that, I was up to nearly 200lbs from a starting weight of 160lbs. So that worked.

There were no apparent Crohn’s consequences from the milk or the vegetables. I did get more gassy and bloated at times, but no flare up of symptoms or pain. I did discover that brussel sprouts are not really human food as much as they are gut-bacteria food, and that if I wanted to avoid generating sulphurous methane at a rate which would astonish a cow, I should avoid them. So brussel sprouts = bad, at least for me.

That brings me up to December 2010. At that point I was getting tired of milk, and had started to break out in acne on my upper back. That seemed like a clear indication that milk, even if it wasn’t going to trigger Crohn’s, was probably not helping overall. I also hurt my back and had to take a break from weights for a while, so there was no point in chugging that much milk.

So I decided to give the starch hypothesis a direct test. I started eating potatoes.

I did experience some discomfort at first, but no real Crohn’s symptoms. It seems that my digestive system had to reset a bit to handle a pile of starch. Again, I would have more gas (as in gas at all; the meat only diet left me without any) with the potatoes, but no Crohn’s flare. I’m still eating potatoes now, eight months later, with no obvious consequences and no Crohn’s activity in my latest biopsies.

Hypothesis falsified?

Was Wulfgang Lutz right? Just eat 72g of carbs of whatever source and you’ll be fine?

I don’t know. One could argue that the year of zero starch allowed my intestines to heal sufficiently to the point where the bacterial mimetic necessary to generate the autoimmune response are no longer crossing the gut barrier, and so the starch hypothesis stands. Or maybe I didn’t need to eat only meat for a year – maybe just dropping the total starch load to some lower level would be sufficient, ala Lutz. Or maybe the starch hypothesis is total crap and I just happened to have a flare up and remission which coincided bizarrely well with a radical shift in diet.

The one thing I have not tested myself with is gluten. Maybe all of the above is a red herring, and removing gluten and various grain proteins from my diet caused the gut healing necessary to shut down the Crohn’s reaction. I was tested for celiac and came up negative back when I was first diagnosed, but frank celiac and gluten sensitive are different levels of response. When it comes to generating totally unscientific explanations for the results of my N=1 experiment, I’m coming to think that it might just come down to avoiding bread.

I did have a few moments of insane cramping and diarrhea over the past year. In each case, I could not ascertain a direct cause. It seemed to happen at random, but usually coincided roughly with some deviant behavior. I really can’t say if this is just me finding patterns in chaos, but when I eat a lot of nuts (pistachios are apparently equivalent to crack cocaine for me), I usually end up in trouble. Unfortunately, I was also eating some fruit at the same time I was gorging on pistachio, so maybe it was fructans in the fruit. I have yet to do any real exclusionary experimentation to isolate which food(s) were sending my guts down the toilet, mostly because “success” involves my guts trying to jump out of my body and down the toilet.

So, there you have it. I’m still “cured” despite adding in a number of foods which a year ago I would have predicted would cause a relapse. Who knows what I’ll be saying in a year or two. I’ll make one golden prediction: I’ll be less certain about the truth of the matter than I was when I started.

In the meantime, though: no colitis!

Wednesday, August 11, 2010

Concluding Thoughts

I woke up from my colonoscopy with my traditional confusion and disorientation. I recall the doctor walking up and saying that things looked fine and that they had removed a polyp. He let me take home the pictures from the polyp removal and his writeup about it. Nice guy.

I guess that polyp that my previous gastro thought might require surgery to remove had morphed into a non-problem over the past year. I compared the pictures from my 2009 colonoscopy and the polyp looked fairly different – in 2009 it was white and puffy, in 2010 it was the same color as everything else and looked smaller and denser. I have no idea if these statements make any sense or are even true, given that I’m just comparing pictures on a piece of paper, but there you have it.

I got a call from the doctor’s office yesterday saying that the polyp was benign and everything is fine. I should come back in a year for another colonoscopy.

So here I am. One year after embarking on what I thought was a fairly radical experiment, and the sum total of my medically noted results is “Everything looks fine.” Talk about an oddly deflating experience. On the one hand, this confirms that I am in a medicine free remission, that I am generally healthy and free of Crohn’s activity. That is massively good news and a confirmation of the Hypothesis. On the other… well, everything’s fine. Could just be a fluke. Who knows?

So with that little humbling thought, here are my takeaways from a year of very-low-carbohydrate, zero starch eating:

1) It appears to have been effective at maintaining remission. My first three or four months were quite turbulent and felt as if I was having a flare up, but I stuck with it and the reward is more than worth it. Or maybe I’m just lucky? Epistemic crisis here I come.

2) It is not hard to do, provided that one actually is interested in the outcome. I’ve been continually perplexed by the hangups people have about food and the preconceptions they refuse to let go of in the face of evidence like my lack of dying. How on earth can anyone say, “Oh there’s no way I could do that.” Seriously? There are people on this planet whose entire lives are spent in a brutal daily struggle for food that they eventually lose based on the arbitrary whims of an unfeeling universe, yet the idea of eating a calorically and nutritionally complete diet of meat, eggs and cheese for a year is inconceivable.

A lot of this has to do with not having any stake in the outcome of the experiment. It’s easy to not think through a statement about the diet if the only time you think about it is the once a month you happen to notice what I’m eating, and then make some idiotic claim about how it’d be impossible to handle. It’s not only not impossible, it’s trivial. You simply have to know some basic facts about why it’s a worthwhile approach, commit to a goal, and then do it. Perhaps I’m too impatient with other people’s frailties, but even that is hard to accept because I’m about as frail as they come. So why is it that this wasn’t a disastrously difficult experience for me despite the near unanimous outcry of how hard it must be?

People just don’t ever think about what it means to eat, about why they eat, or they just don’t care about their health enough to do so. If they did, they might find giving up certain foods to be fairly simple. Ignorance is bliss, I suppose. Of course, I was and likely still am one of the ignorant, but man oh man do I hope I wasn’t so blatant about it in the past.

3) Ebringer’s research really, really deserves more attention in the Crohn’s patient and research communities. Maybe I’m a fluky n=1 random event, but I doubt it. Browsing through the mainstream articles and forums is an incredibly depressing exercise in watching the conventional wisdom of “there is no cure, prepare to suffer” stifle people’s attempts to find relief. The CCFA’s criticism of the Specific Carbohydrate Diet was a ludicrous read - I hate conspiracy theories, but it’s like the mainstream doesn’t want there to be a way to manage the disease without constant medication, so anything that promises such must be attacked with tenuous logic and absurd “warnings” like “children might not get enough calories”. What?! Fearmongering bullshit at its worst.

4) Just try it. It’s one year of your life and it may improve every other year you ever live. We like to talk about putting in your time and making investments, but it’s rare that we have the opportunity to do so in our own lives with such a radical payoff. There is no guarantee of success, but there is a guarantee of failure if you do nothing.

I went back and reread my introduction post and I wanted to offer up some thoughts about how my perspective has changed since then.

I relied almost entirely on ethnographic observations to get me to this diet. The only modern clinical evidence I saw was Lutz’s claim of 80% remission with a low carb diet. While this was a happy outcome, I’m now much more leery of relying on such a shaky foundation for diet – I don’t think I posted anything that’s outright false in that introduction, but I far prefer the work of Ebringer as a foundation for low starch eating in inducing/maintaining Crohn’s remission to a collection of random observations about the general health of primitive populations.

Those biases eventually lead me to the “paleo diet” movement that is bouncing around the internets as we speak. Basically, the theory goes that since humans evolved over a time span of millennia, we should focus on eating the foods which most closely resemble those we evolved to eat, while avoiding those which are too recent for humanity to have adapted to. The closer to the present a food was invented or introduced into the pool, the more skepticism it should be viewed with.

I have my disagreements with various takes on paleo. I dislike the magical thinking and speculation that it seems to breed, the caveman metaphor, the constant optimum seeking and above all the orthodoxy of thought that any principled approach to eating engenders. However, I like the basic premise and I like how it provides a pretty simple and accurate mental model for selecting healthy food. Sure, maybe a given individual can tolerate gluten better than someone else, but they don’t really miss out on much by eating more meat instead of bread. And if they experiment and have no problems, hell, add it back in.

Generally speaking, I think I went through the process of being a new convert and now I’m back to being a relatively cynical skeptic with some new biases based on some new experiences. We’ll see how well that bears out.

So, that’s it. I did it. I ate pretty much an all meat diet for a full year. I did not die. I did not get scurvy or any evident deficiency. I ate a lot of cow and I’m in apparently good health.

I turned 26 this weekend and for the first birthday in about five years, I didn’t have to take four grams of pills.

Best present ever.

Tuesday, August 10, 2010

Final monthly roundup of measured data and analysis.

Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:
The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.
The "Weight Chart Daily Graph" worksheet shows the daily morning weight.
The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.
I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.

July was spent largely on vacation. My data for the month is thus somewhat sketchy, but generally speaking I was fine. We went hiking in the Adirondacks again (just like in August of last year) and once again I felt fine walking up mountains. Well, maybe fine is the wrong word – I was able to do it and fight through the pain of walking up the side of a mountain.
There’s not much to say. I feel fine. I weigh about 15 pounds more than I did when I started. My bowel movements are regular, healthy and I rarely get diarrhea. It’s been a year and I’m pretty sure I’m in a drug free remission. Success?
The final colonoscopy is scheduled for July 30th. I’ll find out then.

(Note: Posting this pretty late because I'm lazy. The next post will deal with the post-colonoscopy review and concluding thoughts)

Tuesday, July 13, 2010

June Weights and Measures

Elevent monthly roundup of measured data and analysis.


Since blogger is annoying in how it handles images, I’m going to upload an Excel (2003) spreadsheet. Here’s a link:


The "Weekly Graphs" worksheet shows the weekly average of weight and the weekly average combined BM score and quantity. Also added average frequency.

The "Weight Chart Daily Graph" worksheet shows the daily morning weight.

The "BM Score Daily Graph" worksheet shows the daily combined BM score and quantity.

I'm keeping a food log and notes in a written notebook, which for the sake of putting off an annoying task, I will scan and upload when I'm done rather than every month.


June featured a long vacation which thoroughly disrupted the data. I went to England to visit my parents, and discovered the wonders of the British dairy aisle. Shockingly enough, each container of “double cream” contained… just cream. No random other crap added in for no good reason. Tasted great and very thick as well.

I was pretty digestively sound in England, returned for a week, and then embarked on a trip to the beach, which also disrupted my record keeping for the start of July. Thus, this entry will be short – except to note one important thing:

My year is almost up!

It’s incredible that July 20 is approaching so quickly. One year without eating anything but animal products and not only am I not dead, I’m feeling fine, have plenty of energy for strenuous activity like paintball and appear to be in excellent general health. Such subjective measures mean nothing, of course. The only real test will be my colonoscopy on July 30th and what the biopsies show.

I initially intended to make some predictions, but this past year has taught me that I know too little for that to be a worthwhile exercise. I find myself with little confidence in any prediction I can come up with. The polyp found last year might have become cancerous, or maybe it’s gone completely, or maybe there’s been no change. I’m definitively asymptomatic when it comes to overt Crohn’s symptoms like cramping and diarrhea, but I do get a twinge now and then which makes me wonder what’s going on down there. What will the biopsy show? Maybe I’ll look like hamburger, or completely cured, or maybe I’ll just look like a guy with mild colitis like always. Gotta love uncertainty.

Suffice it to say that I’m anxiously awaiting the results and hope that they’re as positive as the experience itself has been. There’s nothing worse than thinking, “Wow, this must be really working!” only to get a cold bucket of medical reality in the face.

My next post will be a look back over the past year, focusing on the things I was wrong about, lessons learned, and what I’ll do with the next year. Till then… one month to go!