Why San Antonio kicks Dallas's ass

Dallas and Houston (and to some extent, Austin) walk around with noses in the air, either sincerely believing that they are all that and a bag of chips, or wanting everyone else to think that...or probably both. But pride indeed goeth before the fall, verdad? Truth is, these cities aren't so great. Plagued by aggressive drivers, frustrating traffic congestion, horrible water treatment, choking smelly air, and alpha-male temporal lobe-dominant attitude, it's getting to the point where you couldn't pay me to live there. At least, not anymore.

Enter San Antonio. San Antonio edged itself into my life by way of a combination of intuition, logical natural progression, the egging on from other people, and some basic research. San Antonio is cool for all the reasons the wrong people say it's uncool. I've encountered several people who, well-meaning as they may have been, have expressed a disgusted surprise when we answered their post-grad questions with "San Antonio". They genuinely wonder why we would want to go there. How badly I wanted to answer, "because people like you say things like that". You see, I want to go exist in peace, where the alpha-types couldn't stand to be, because that means they won't be there.

In all actuality, San Antonio, with its un-flashy humble pride (an oxymoron that only San Antonio can pull off successfully), quietly kicks the ass of any other US city, especially those cities that think they're all that, like Dallas, Houston, Chicago, LA, and practically any other city on either coast, especially the west coast. Sorry, that's just the way it is. My physical body returned from San Antonio just today, although I swear my brain is still down there, somewhere on Blanco. Said notes are shared henceforth...

The People. You've gotta be a real special snowflake asshole to not like the people here. They're friendly and commonsense, with an uncanny ability to walk a delicate line between proud/loyal and respectful/humble. They're friendly, with a long fuse and a tendency to give you a break or at least the benefit of the doubt. They'll let you in on the freeway, even when it's obvious you don't know where you're going. They don't sit on your ass, kissing your back bumper. They don't keep a trigger finger on the horn, waiting for you to make the slightest mistake. They actually use their turn signals and they give you plenty of room after they've passed you before they try to merge back in your lane again. The servers at the restaurants smile, help you out with the menu, and don't try to practically push you out of the table by bringing your bill before you're completely finished with dinner. Even Black-freakin' Friday at the golldang mall was surprisingly benign, polite, and non-electric. No need to go in with boxing gloves on, ready to swing. It was a delightfully painless experience. And no, I didn't need a traffic report on the radio to warn me about how full the mall parking lot was; there was plenty of parking.

The Culture. Unfortunately, it's not for everyone. That's not saying anything bad about SA, that's saying something bad about the rest of the people everywhere else. The culture is a laid-back amalgam of a vast array of ethnic backgrounds, all seemingly dwelling together in amicable coexistence, without so much as a skirmish. Mexican, German, Asian (especially Vietnamese), and Native American are all represented. What's especially cool is, these cultures weave together, remaining strong and pure, without compromising themselves. They don't tiptoe around some timid political correctness, they just are what they are and they're not hiding, afraid to be and express what they are. Despite this, comes the coolest part of all: there's hardly any racism. No matter what you are or where you come from, as long as you don't walk around like a pompous prick and make an ass of yourself, you're welcome here and you can just be yourself.

There is also a more thorough integration of classes in SA. When driving through a particular part of town, you can't write off a whole neighborhood by having seen only one street, you have to consider each building or house individually, evaluating the area on a house-by-house (or building-by-building) basis.

The part that is not for everyone is that it is very laid-back, and very simple-minded (which I mean as a compliment!) small town, with simple priorities and philosophies. There's not much nightlife. Aside from the Alamo, the Riverwalk, and a handful of other tourist attractions scattered around downtown, there aren't that many highlights (although the attractions we have simply just plain rock). It's a small town, with every quality that a small town has--it's just that it's a small town dozens of times over, a bunch of small towns laid end-to-end so that together, they form a large spread out area. But it's not a fast-moving, flashy, happening, A-list type of place with hip, trendy digs at every turn. You don't have to be on the guest list, because all there are are some neighborhood hangouts. Some people want more action than this. Some people want to play, to patronize dance clubs and arenas. Some want to meet hot singles and play. San Antonio is a calm family town full of people whose priorities are more mature. Don't get me wrong, there is still plenty to do here, and a lot of it is low cost or free altogether. But it's not the kind of town that values shallow status symbols. Put the I-want-to-impress-everyone-at-the-office-water-cooler conversation away, because it'll get you limited mileage here.

The Scenery/Environment. Like the people and the culture, the physical surroundings rock. Many parts are full of hills and trees, and people from Dallas and Houston will experience a nice surprise: they can breathe here. Why? Because the brown layer that hovers over the horizon in Dallas (which sits in a bowl, and I haven't heard anything better about Houston, either) is refreshingly absent in San Antonio. Maybe this's why we can actually fill the truck up with real gas here--the pollution is low enough that the EPA hasn't put the smackdown on the city/county to force less-than-real gas upon us. The views can vary from excellent to non-existent in the hilly parts, and the terrain can be flat and treeless in certain parts of town. But for the most part, it's twisty-windy streets, a tree canopy over the yards and roads, and relatively decent air. The water is awesome, too. Why our north Dallas suburb water (which is supposed to be quite well-to-do) literally reeks the second you turn on the faucet, of both mold and chlorine at the same time, I will never know. It takes an act of something special to pull that off. San Antonio, though, tastes no worse what you'd expect city-treated water to taste like. And it doesn't stink.

The Infrastructure. I spend an obscene amount of my life behind the wheel and as such, it's important that I evaluate the infrastructure. One of my greatest stresses is traffic, and bad drivers top my list of pet peeves. It's a blessing that SA has, for the most part, decent drivers who are generally waaaay more courteous than practically any other major city. This is more than I can say for Dallas. Thirty minutes in Dallas traffic is more stressful than 3 days of nonstop all-day driving in San Antonio or even a week of the same in Saskatoon, Canada. As for SA? This city had a bright idea: let's build infrastructure to actually match the traffic it's going to hold. How's that for an idea? Bonus points: SA's freeways don't even need an HOV lane, because traffic doesn't back up quite that bad on quite that regular of a basis. And yeah, you heard me...freeways. There are no tollways--at least, not yet.

The Atmosphere. It's interesting. Malls? There are a few of them, and they have a good mix of the national staple chain stores and those few-of-a-kind dives that the tourists don't recognize. Parking is plentiful and most stores don't try to nab you for every upsell (except maybe New York & Company, which was as annoying as a Disney DVD in which you have to get through 15 minutes of preceding ads before you actually get to the real movie), and for the most part, the kiosk salespeople behaved themselves. Restaurants? There are plenty of them. They're generally one-of-a-kind or close to it, and they often make their food from scratch and sell a decent portion for a reasonable (or even downright cheap) price. The ambiance is fine, and you can almost always carry on a normal conversation. One restaurant even has an celiac-friendly menu, complete with all the appropriate substitutions so that someone with Celiac Disease can eat out without worry, and enjoy it, without having to make all kinds of picky substitutions. Other entertainment? Tons, and it's affordable. There are a gazillion places to go bowling or mini golfing. There are dollar theaters, too, a couple of gyms (although no Massage Envys or other discount massage facilities, thankfully), and some decent neighborhood parks. Like I said, these are simple people (and I mean that strictly as a compliment, by the way). They are low-maintenance and don't need to be constantly entertained throughout life.

Other miscellaneous ways that San Antonio whips Dallas's ass:
* SA is actually trying to revitalize their more rundown areas.
* SA has the Spurs, and not the Mavericks or the Cowboys.
* Evangelists do not have nearly the stronghold on SA that they do in Dallas.
* SA is known for its thunderstorms...and not its tornadoes.
* SA generally displays "Support Our Troops" bumper stickers instead of Obama '08 ones.
* Bexar County is infinitely more animal-friendly than Dallas county ever was.
* In SA, shopping is not a powersport.
* I did not have the "Green" movement shoved down my throat in SA like I do in Dallas.
* SA drivers favor common-sensible cars and trucks instead of BMW and Mercedes.
* In SA, you can watch the restaurant server make your guacamole fresh at your table. And, get this--it's priced very reasonably!
* Even the Fox affiliate is less flashy and obnoxious in SA. Now that takes an act of God(dess)!

Thanksgiving, or Forgiving?

There are your plans, and there are some higher power's plans....and in the end, yours don't count. You see, I had today all planned out, a year ago. Yep, we were going to start a tradition. Remember how, last Thanksgiving, my mother, my husband, and I all went to the Texas Renaissance Festival just outside Houston? My dad was out of town so he couldn't be with us, but we simply assumed that this year, we'd be doing the same thing and this time, Dad had planned to join us.

Not so fast. You see, some geriatric whose mental faculties warranted the stripping away of his license years ago managed to slam his big-nuts all-steel pickup truck into my parents' Fisher-Price Ford Escape (not meant to criticize the rents, but merely to impress upon y'all the inequality of the vehicles involved and the subsequent disadvantage assigned to my parents), throw my father 30 feet into a concussion that would ultimately cost him 80% of the hearing in his right ear (permanently), and my mother one of her kidneys among many other serious injuries, all of which involve chronic sequelae and thus long-term care.

It's amazing how fast one second changes everything. In a parallel universe somewhere just out of reach, I'm walking around with my family, bodies intact, throughout the RenFest grounds. I'm dressed up as the custom-made bad-ass warrior princess with ancient Turkish accessories and a semi-functional sword. My mom was planning on she and my father dressing as a pair of pirates. But somewhere in Saskatchewan, there is a stop sign that needs to be twice the size that it is. As it stands, they're at my sister and "brother"'s house, awaiting my mother's surgeries (her kidney's been dead since May and she developed a hernia in July but she's been on a surgical waiting list since August, she's had multiple consults, and the earliest surgery date they've been able to get her is January 19th. How's that for healthcare "reform"? Do you really want government-run medicine? If so, fine. But be prepared to wait, and do not deceive yourself into thinking, for one second, that you'll get the standard, quality, and timetable of care you receive now. Off soapbox).

Funny thing is, though, aside from the healthcare atrocity, I sense a peace that shouldn't be, considering everything that happened this past year, and everything that's slated to happen this next year, but it's there, big as life. We packed a truckload of books and unopened packs of twin sheets to use for massage therapy, and we strapped it down under a huge green tarp and went. Coming into the small rural area in which my parents live, an area that up until now had always been one of slightly oppressive isolation and extra-sensory astral murk due to my uncle's slow, agonizing neoplasmic death several years ago, I still felt a warmth and peace. Something told me that it was OK to be there. It felt slightly strange unloading our stuff from our truck and into the workshop near the house, a feeling that could easily be attributed to the fact that after what seems like forever, we're leaving our house, the house that was supposed to be home until the end of time, because of how perfect a match for us it is, and the fact that I would have liked to have moved for the last time. (Well, we could've succeeded had we made a more palatable decision, someplace--in Texas--other than Dallas.)

But still, it feels oddly comforting. I can't describe it. It's infinitely more palatable than I had once thought. Hell, it's beyond palatable, I'm downright out-and-out LUCKY. We have a place to live and a great setup at that, and an open invite to stick around a while. We can now begin to realize our dream, several years ahead of schedule. I'm quite thankful.

I'm also thankful that although I don't get to spend Thanksgiving with blood relatives, I do get to spend it with an incredible husband, who has parallel visions and identical thought patterns when deciding on what we want to do. I'm thankful that we're thisclose to finishing school. I'm thankful that we're not being forced to move or shed our house due to being financially strapped or in an otherwise bad situation. I'm thankful for being able to eat food, the fact that someplace was open--even if it was Dairy Queen, it was something.

Above all, though, I'm thankful that my parents survived their accident, walking and talking like they were almost their old selves again. Sure, some innocence has been lost (let's face it--there are still stones unturned, even in middle-to-later adulthood). They now have memories that no one should be stuck with. But when all is said and done, they're still functional and they can live independently, enjoying pretty much all the activities they took part in before. Once their bodies are repaired, they'll be able to go on with their normal lives, almost as they were before. (Maybe then I'll be able to forgive the bastard that hit them; until then, he can burn in hell for all I care. But...) Time will heal...eventually. And when it does, maybe we'll get to go on a little jaunt to the RenFest grounds north of Houston over next year's Thanksgiving weekend. And we'll start our tradition after all. Dressed as warrior princesses and pirates of the Caribbean. Or something like that.

The "P" is for Purgatory (or Plan of attack)

Now that you know what you're up against and what to expect, it's time to plan a strategy for getting through it. At over 9,000 bucks for the privilege of working for free for 4 months, and so many requirements to meet, you've got to be proactive if you plan to finish on schedule. Here are some gems that were handed down to me. Some of them are rule-benders (if not outright breakers), but they're "the way it's done" in order to get out on time. Because I'm selective about who I tell about this blog, I'm OK sharing this stuff here, but don't go blabbing it to just anyone, because it will inevitably get around to the Unfriendlies In High Places, who will predictably close any loopholes and insert new obstacles just for good measure.

First things first. Day 1 of Tri 1, they spring the 10-Recruit requirement on you and advise you to start getting them in right away. Right? Well, yes and no. Recruiting patients to outpatient clinic before you're actually an outpatient intern is a double-edged sword. You should do so because the profs are right: you can start getting patients in early. Not to mention that it's easier (they forget to tell you this part), because if I understood right, all the new patient has to do is show up for an exam and poof! They're a recruit. Once you're in outpatient clinic and you're recruiting them as your own patient at that time, getting the recruit credit isn't quite as easy. There's more to it, more steps to go through. However, be very, very careful who you refer your prospective patients to. Ideally, seek out an upper tri (the best way is through clubs that meet over lunch--that way you know you share some common interests) and form an alliance with them. When your prospective patient wants to come in, have him/her call you first and (ideally) set up the appointment through you. Act as sort of a liason. That way, there's no question in the upper tri intern's mind about the source of the patient. Most importantly, make damn sure your name and ID number appear all over the patient's intake paperwork (supply them with this and instruct them to specify that it was you who referred them). I never recruited patients in this way but I know some who did. Some got burned, but it was usually a lack of instruction given to the new patient, and a lack of following up on (and tracking) the status of the credit to make sure it goes in your name. I know others who did get almost all of their recruits in even before starting in outpatient clinic and they did quite well. It was nice to have that (often big) stress behind them.

So yes, we have to recruit patients. They're not kidding. People have indeed been held back from graduating simply because they didn't meet the minimum number of recruits. People who struggled through clinic saw that I was getting through OK (even though I did not broadcast this) and asked me how I did it. Patient recruits come from anywhere, as long as it's from the heart. Yeah, it sounds cheesy, but you have to operate from the right headspace in order for this to work. You can't act from a state of desperation, because patients are not stupid--they'll pick up on it in a heartbeat. So what to do? Be confident without being cocky, and step just a bit outside of your comfort zone. The most successful interns I saw pulled in fellow church members or fellow gym/healthclub members. One was a teacher at a massage therapy school and had a captive audience of 20-30 people over the course of 4-6 months with whom to build trusting relationships with, and a lot of them came to see her and/or referred massage clients to her. I was a massage therapist myself, with my own low-volume private practice. People were already criss-crossing north Dallas suburbia to see me, whether from home or from work, so it wasn't a big deal for most of them to drive out of their way to the clinic.

Parker also has a booth at the Texas State Fair. One word of advice: go. Sell the vouchers. Talk up chiropractic. However, make sure the other party is actually interested; I watched some of my (unfortunately) soon-to-be colleagues get obnoxious about it and start practically accosting anything with a pulse. Don't listen to those who say you won't get anyone at the State Fair. You have to operate from the heart and from a place of confidence, because if you are truly ashamed to be there or you think you're wasting your time, then you probably are. You won't get anyone that way. Be real, talk in plain terms to anyone interested, and see if they'd like to sign up. If you handle people nice and easy without putting on the pressure to "sign up today! But wait! There's more!..." then people will feel comfortable with you and if they were ever thinking about becoming a patient, you might just clinch the deal because you now own the most important part of their decision: trust. Another word of advice if you do the State Fair: dress nice (no polos) and when you sell a voucher, try to schedule them right there. (Yep, that means plan ahead and bring your available appointment times with you, written down. Cross them off when a patient schedules for that time so you don't double-book yourself.)

Most of my recruits were people I already knew. You can definitely go this route. If you have friends in the area, or family with a different last name, you can pull this off well. I brought in 3 friends and 4 massage clients. The hiccup was, the school suddenly enacted a rule (shocking) that patients had to attend the health talk after they'd had their exam, so that meant they could no longer attend the health class first and buy the voucher to use themselves. This means they'd have to pay full price ($100 plus) just to jump through all the hoops that finally got you recruit credit. How to circumvent: Line up a bunch of people interested in buying vouchers to be available to do so about 2 weekends from now. Go to the tally office and get the blue voucher kit request form. Fill it out (put your phone number as the contact and make up a location and health talk subject), make sure to check the box that you're doing a health talk ONLY, and NOT a screening (which requires a staff doc). Turn it in. Check back on the availability of the kit a couple days beforehand, because they won't hunt you down to tell you it's ready. Now you have the voucher kit for the weekend--make the rounds among your friends, sell the vouchers (following the instructions in the kit), and schedule the first appointments right then (take your calendar with you). Return the voucher kit on Monday. Not only did they get the voucher for the discounted package, but they also filled out the 1-page health survey that serves as their evidence that they attended a health talk. Now you don't have to rope them into attending one at the school.

Speaking of, let's talk about that little health talk/class every new patient has to sit through. The school claims it's a CCE requirement (nice cover, great excuse, and you'll hear this one a lot), but I don't buy it. Regardless, it's required in order for you to receive recruit credit (I'm not sure if this is the case if you're Tri 1-6, but I know it is if you're an outpatient intern). Some interns had some trouble getting their patients to attend one. (They only have to come to one, and they can choose among various times - usually 8.30a, 2.30p, and 7p.) Patients didn't mind showing up for their adjustment (a plus), but some had no interest in the care class. How to circumvent: the intern who told me about this said that she would schedule their appointment to begin at 3p, but tell them that it was at 2.30p - once they showed up, the clinic was not open, but they would already be there...just in time for the health care class to start. Then the appointment would take place right after that. Problem solved.

Speaking of non-compliant patients...let's talk about reeling them in and keeping them on track. First, take (gentle but assertive) command from the very start. Patients are looking to you for your lead and direction, so deliver the goods. Take the reigns when scheduling that first appointment. Avoid open-ended questions like "when would you like to come in?" Instead, ask if there are any particular days of the week that are good or bad. If you get the gist that they can only do a certain time of day or a certain day of the week, work with that. Offer them specific appointment times.

The next opportunity to set the tone comes from the Report of Findings. Keep it short, real, common-sense, and down-to-earth. Make it about them. Address their questions and concerns. Explain what's wrong with them and tie it in to the symptoms they've mentioned. Without fear-mongering, tell them what's likely to happen down the road if they don't get this treated. Patients are visual people, so conjure up some imagery--again, I stress: keep it real, keep it honest. Here's your chance, don't screw it up. Once they realize what their situation is, impress upon them that you've seen (or heard) of this before, and it has responded well to chiro care (if it has). Explain that at first, you'll need to see them more frequently to get ahead of their condition so you're not going so long in between visits that you're starting from Square One each time, so that would typically require "x" number of visits per week for "y" weeks, to start off. Emphasize that as they get better, the frequency will drop off until eventually they're just mainenance (here's a good time for a dental checkup analogy). Once you've indicated the treatment frequency, they know the score. They get the big picture.

Then, you reinforce compliance with each visit. If they're even 3 minutes late, call them. If they no-show, remind them of your personal cancellation policy, explaining that it's only fair to the other patients who may have wanted that spot but got turned away because it was already reserved for the person who ended up not showing up. Each time you treat them, schedule the next appointment before leaving. Most of the interns I saw struggling through clinic had a tough time taking control of the scheduling and they let the patients schedule themselves. That's like letting the inmates run the asylum. When setting that next appointment, have several specific time slots in mind, and have them choose. Even if your day is wide open, don't let on as much.

Finally, if a patient starts to become unreliable, schedule them either at the end of the morning or the end of the day. This way, if they're scheduled at noon and they don't show, you get to take a long lunch. If they no-show for their evening appointment, you get to go home early instead of having to wait around for a patient after them. If a patient becomes a chronic no-show, do your part by attempting to call them and note your attempts in their file. Finally inform them that since their file has been inactive for "x" number of weeks/months, you'll need to close their file, but let them know they can start care under another intern at a later date anytime they'd like. And then let them go. Walk away from them, especially emotionally. Don't take it hard; it's probably not you.

Another piece of advice given to me was, recruit in waves. Get a couple of patients in. Get them examined and start them on a treatment plan. Then, as they get re-evaluated and their frequency starts tapering off as they improve, bring in a couple more people and examine them and get them started on treatment. This keeps you steady, so that you're not too overwhelmed with a ton of patients from the get go, nor are you freaking out later like some other interns I talked to because all their patients evaporated at about the same time, leaving them with a lot more adjustments to get and no one else to readily recruit.

Let's talk re-evals. This is probably the iffiest part of the post, but it was one of the most valuable insights someone gave me. Every time a patient is due for a re-eval, do an SRU. Protocol assumes you'll do an RRU--how nice of them--they effectively soak up a large chunk of your time for something you don't get exam credit for, and they do make a little money off the patient to boot. Wow, you'd think they did that on purpose. Oh wait... Meanwhile, you've got 24 required exam credits to get, so what's an intern to do? Here's the deal: when you re-eval your patient, make sure they have a different chief complaint. You need not change the underlying diagnosis; their condition is still the same. But if the main area of complaint is different, then you can do an SRU, which counts as exam credit. Make sure to code for 99213. You might get told to code 99212; do NOT do this, you will NOT get exam credit for this code. Also understand the dirty secret about extremities: extremity exams are also not credit-worthy, and neither are extremity adjustments (although they do charge the patient for these too...and as far as your credits are concerned, they are worth absolutely nothing to you). Warning about SRUs: don't attempt them on patients who are faculty staff doctors. They know what you're trying to do and will bust you. Also, do NOT do this with Medicare patients. Their chief complaint can't change or you'll be losing credit for a whole whack of their adjustments somewhere down the line.

Yeah, while we're on the subject of coding, do your patient a favor and fix pretty much everything you find wrong with them, but when it comes to the fee sheet, mark the 98940 if they're private pay. I fail to see the point in charging people more just because you adjusted more areas. To me, that feels like nickel-and-diming, and your patients will see it that way, too. Everybody does it this way. Now again, faculty don't pay for their care, so go ahead and mark 98941. In fact, it's probably best to do this, because statistically, you should have a certain percentage/ratio of 98941's, but I don't know any specifics on that.

On the subject of Medicare patients, be very, very careful in how you code. Do NOT rely on your staff doctor, no matter how competent they are or how much experience they have in the field doing Medicare, or anything else. The school has a printout of the guidelines for coding, and they're at least clearer than mud (which is more than I can say for most of the school's other policies). Know these guidelines inside and out, because a Medicare adjustment is NC (No Credit) until proven otherwise. Make damn sure your Medicare patient has a spinal chief complaint--no extremities allowed for a CC--and make sure your exam and DX codes are all spine-related. Medicare will not cover extremities, so you'll get NC'd (I know a student who got 40 adjustments thrown out for this and had to spend an extra 1-2 trimesters making them up). Make sure there are 4 legitimate DX codes in the blanks, too. You'll need them because technically, your staff doc is supposed to do the first adjustment for their first 2 codes, and then you do the rest, pertaining to codes 3 and 4.

A note to all of you coming of age right behind us: try to take as many x-rays as you can in student clinic, because those patients don't pay for x-rays, so it's a lot easier to talk them into getting films when they don't have to pay for them. Try to take full spine as much as you can. You have 15 interpretive reports to write, and each series is a separate report, so you can get 3 report credits on a single person's full spine. You could do 5 of those and technically be done with those before you even enter outpatient.

Let's talk lab work and radiology recommendations. There's only one caution I can think of here, and that is that several interns that graduated before us were held up from graduation due to the fact that they hadn't properly addressed any existing lab or rad recommended follow-ups (or they had, but hadn't documented as much). These recommendations are flagged in the reports you get back about a week after the x-ray or blood draw. These interns had to have the patient come back and sign the report indicating that they knew about the recommendation and whether they elected to or not to follow up on the flag. Yes, the patient apparently had to physically come back to the clinic to sign. Don't get caught in this situation; it can delay your checkout!

That's all I can think of for now. Our Thanksgiving trip will come too early as it is :)

Be careful, my pretties--it's a jungle out there.

The "P" is for Purgatory (or Pain)

I've written some "getting through Parker"-themed entries before, but this deserves its own post (or several), because clinic is its own beast. If you're in Tri 6 or above or you're close to someone who is, you know what I'm talking about. When our class had just started outpatient clinic and we dared to compare notes with each other, I quickly realized that as alone, awkward, incompetent, and overwhelmed as I felt, I was actually not alone. In fact, more people had parallel experiences than not--many more than I ever imagined. As I progressed through clinic into the top tri's, I found myself giving pep-talks to the under-tri's--the same ass-saving words of adviced I had received from senior tri students just a few months before--in an effort to introduce some peace and comfort into the prevailing vibe of anxiety and desperation. And when I started making half-joking noises about writing an unofficial, unauthorized Parker Clinic Survival Guide of sorts, I actually got a lot of encouragement, and they were serious. So, here it is...

The first thing to keep in mind is a very simple concept: they want everyone to have to spend an extra trimester there. No, you're not imagining things. With tuition on the automatic increase every January, it seems as though December graduate-hopefuls are under just a bit larger of a microscope when it comes to scruitinizing credits, and the Axe of No Credit seems to swing just a bit easier in the house's favor. Or so I've been told. Understand and accept that everything you do has to be waterproof and airtight, because they will nullify the entire superbill, and all of its accompanying credit, on a simple technicality, even if that technicality had no impact on either patient care or the school's revenue. Understand that there is indeed a motive hard at work here, penetrating and motivating every decision made. If, despite all of the speedbumps and roadblocks, you're rocking and rolling your way through your requirements, you'd best keep it on the down-low, because if too many people do this, admin will indeed add another hoop for you to jump through, and chances are you won't be grandfathered in.

Now, that's the administration. Enter the attending staff/faculty doctors that oversee and approve what you're doing. They are usually on Team You, at least to some extent. They want you to succeed. They want you to meet your numbers. Their job depends on it; your numbers are their numbers. Part of their salary is based on the productivity of their interns. (Kinda adds validity to the conspiracy theory; if you're not able to adequately meet your numbers, they extract another trimester's worth of full tuition from you, and they need not pay your doc as much. What about the extra revenue they'd generate from patients if the clinic is nice and busy, you ask? Ha. PALE, in comparison to your tuition. Think a patient will ever end up paying $9200 worth of care in 4 months?) So anyway, the staff docs want to see you make it. They want to mould you in their image. Well, some of them do. They all have their reasons for being there, as opposed to real world practice; some, like mine, burned out of uber-successful megapractices, while others couldn't hack private practice and also couldn't admit as much, and came running back to their alma mater. The latter category could give two shits about your success; they're just happy not to be bagging groceries for 8 bucks an hour. But as for the good staff docs, pick their brains. Have them show you some of their tricks of the trade. As far as numbers go, while they can't wave any magic wands and make patients appear out of thin air, they just might could pull you a few strings come crunch time. So keep them in your back pocket.

Now that we know the players, let's set the scene. Opening Act, Tri 7. There are no two ways about it: Tri 7 is an emotional beating. Rationally, it shouldn't be, because the pressure cooker classes are starting to open the release valve, and you're out of Student Clinic (thank God). You can now treat real people and start etching your groove, laying down the foundation you will draw from, quite possibly for the rest of your career.

But in Tri 7, you're missing a very critical component in making that dream come true: patients. Make no mistake, they're scarce, and you're generally on your own, at least for now. If you're going to get any numbers at all this Tri, it's because you made it happen. (Hint: spend as much time as possible in your pod, in front of your staff doctor.) Nobody else is helping you out or holding your hand, and you're going to feel largely ignored and passed over. As hard as it is not to worry, don't. I know, it's easier said than done, but seriously, everybody around you is going through the same thing.

Don't feel shortchanged by your brethren who brag about hitting the ground running with five appointments scheduled the first week. I've personally seen natural law do funny things, like five appointments become zero. So, don't count any chickens before they hatch, because it ain't truly over until all is said and done, and even once it is, don't go bragging about it. On the flipside, don't freak out when you realize that Tri 7 is almost done and you don't even have 20 adjustments yet. Don't start doing the math at this point and wake up clenching your teeth because at this rate, you're only going to have 60 adjustments by graduation, which is less than half of the 200 needed to graduate. If you remember the fairy tale about the Tortoise & the Hare, good, because I see it alive and well every day, and it'll help you to keep it in mind. If you're not familiar with it or you've forgotten, look it up. You'll be glad you did.

Tri 8 gets better. At the tail end of Tri 7, you may (or may not) have been thrown a few bones (i.e. upper tri students pass hand-me-down patients to you). Keep in mind that many of those patients were personal friends of the previous intern who may have been under care for the sole purpose of helping that intern through school, and now that the intern is done, the patients may not have any intention of continuing care. A few transfer patients, however, may decide to come in for you; most of those have already been patients forever. The more time you spend in the pod around your staff doc and upper tri interns, the better your chances of scoring transfer patients. Any help you get by way of patients will probably come from other interns and not your staff doc; in fact, you'll probably wonder when you'll start to get any help and you'll feel like people all around you--even those in your class--are passing you up. My own experience was similar to what I'd heard from others; I didn't hit my stride until the latter part of Tri 8. That's when I finally discovered there was light at the end of the tunnel.

Don't be surprised if you still feel incompetent. Some things will start to come together for you (particularly if you're an experience-based, hands-on learner), like paperwork, clinic procedures, diagnosis and differential diagnosis, and some of the common "chiro" conditions like whiplash and degenerative disc disease. Life in general gets smoother because you really start to feel the tapering off of the academic classes and you now have morning and noon availability that you didn't have before.

Tri 9, in a way, is cake--at least compared to the other tri's. Classes have now disappeared completely off your radar and they fade into the rearview mirror surprisingly quickly. Your evenings become yours again, for the first time in 3 years or so, as you now only have one task: get through clinic. That's it. You treat patients, do your paperwork, and then you get to go home and actively choose what you want to do with the rest of your evening. Now, I have to warn you--there is more to clinic in Tri 9 than there ever was before this. With nearly carte blanche autonomy over your own schedule, you can now see patients any time, and you'll get the bulk of your numbers this tri. So again, don't sweat it if you're coming into Tri 9 with a light tally sheet--here's your chance to shine. Don't forget about rad rotation, arbitrarily inserted into your requirements just when you need that time the most for other things, but alas. And of course, there is always paperwork. But everything else is behind you, you're starting to gain solid ground, and it's a nice feeling. And before you know it...

What your massage therapist wants you to know

Hi-ho, it's your favorite massage therapist, even if it's for a limited time only. And I've been doing a lot of reflecting lately, as we get ready to close one huge chapter of our lives and venture out into the pitch dark to open another. I feel like a neuron (nerve cell) who knows it's about to cease functioning (at least, in this particular capacity, as a massage therapist and med student living in Dallas) and sends out that last sacrificial lamb burst of energy to the surrounding neurons to give them one final boost. Relax, it's symbolic.

In the grand scheme of things, I wasn't involved in therapeutic bodywork for all that long, but with the average massage therapist leaving the field after merely 2 years, I'm practically a veteran with my 5-6. I don't necessarily feel like one, because the massage therapy field is so vast one could actually maroon themselves in it, and I haven't even scratched the top surface. Regardless, I found myself accumulating a collection of pointers that I started to impart practically every massage client that graced my doorway, and now I will share them here, in case anyone stumbles across this--therapist or client--and it happens to help. So this goes out to all the dear past, present, and future clients out there, no matter which massage therapist you see...

First, I need to get some semantics out of the way. We massage therapists are massage therapists. We are not masseuses, and we tend to cringe visibly at the word, because that word, no matter how legitimately it started out, now has an entirely different--and illicit--connotation, one that the legit licensed therapists out there have strived and struggled to distance themselves from. And that is the land of the happy endings, the backroom services, you get the point. By calling me a masseuse, you are essentially reducing my status, education, training, services, and value, to that of a hooker. I am licensed, educated, and legit, and I find the word highly offensive. There are some therapists that don't, but the majority of us do. So please don't make yourself look stupid.

Whew. That's out of the way. Second: massage therapists aren't psychic. I wish we were. Some of us have 6th senses and extra-sensory perceptive abilities, and a handful of us just might be downright psychic, but that's more the exception than the rule. Thus, if something is on your mind, please do speak up. You won't hurt our feelings. If the room is too cold or the pressure is too deep or the music too loud or soft, we won't know unless you tell us. If you say nothing, we're assuming all is hunky dory. Most of us will check in on you periodically during the session, and when we do, there has never been a better time to tell us if something is bothering you. There are some things we can't control, especially if we're working in a shared space or a facility we don't own, but we can control a lot of factors. (If you are more particular about your environment, I do recommend you see someone who works out of their home, because they can control everything from the room temperature to the cleaning products and laundry detergents they use.)

Next, please be truthful on your intake forms. Those forms are not meant to shove a microscope up into your business or track every move you make through the FBI's Carnivore system. When I ask you about your occupation, it's not like I'm going to charge you more because you're a high-level sales associate or think less of you because you bag groceries at Tom Thumb. See, I'm not looking for demographics so much as I'm looking for what your work environment is like: stressful deadlines to meet? Long hours at a computer? Lots of driving around all day? Pressure from the boss? Physical hard labor? And please--putting "entrepreneur" on your intake form obviously tells me nothing. Some people put this to try to impress others. It doesn't impress me. I'm an entrepreneur, too.

Now for please-be-truthful-on-your-intake-forms Part B: yes, I need to know your medical history. I know that from your perspective, I'm simply rubbing oil into your skin and making your muscles feel good, and all these questions about health conditions and previous injuries and medications are unecessary overkill. My job and its effects go a lot deeper than you might think. What I do can have a profound systemic effect that affects multiple major body systems. I need to know if you have high blood pressure. I need to know if your car rolled over 6 times on its way into the ditch, even if it was 5 or 10 years ago. I need to know if you have a contagious disease so I can protect myself and the rest of my clients. I need to know about that hip replacement or the reconstruction surgery or that herniated disc. And yes, as embarrassing as it may be, I need to know about any male enhancement supplements or medications you're taking. Because I need to know if I need to make any modifications to your massage so that you get as much benefit as you can and I can accomplish that as safely as possible. Yes, I know how to do this; it's part of our training. And here's the deal, y'all. At the end of my treatment form is a sneaky little statement that says something to the effect of, "I haven't left anything off or lied about anything", followed by the signature line at the bottom. And if you sign it, you're promising me you told the (whole) truth, and should the unthinkable happen and something goes wrong and you blame it on me and you had a pre-existing condition that you withheld from me and now you want to sue me because you think I caused this, you're outta luck.

Massage therapists have been known to work miracles. That's why people swear by us. But let's face it, we don't do everything. We can't "crack" your neck. We can't prescribe anything. We can't diagnose, so we can't tell you for sure what's wrong. Assessment of various conditions can be part of a therapist's training, so those of us who have learned how to assess can give you an idea of what might be going on from an overall muscle point of view, but we can't say for sure. Some of the aches and pains you feel might be tight muscles, or they might be some various bones slightly out of place, or they could be some vascular problems. Sometimes it's really hard to tell, because a joint slightly out of alignment can feel like a muscle ache. Massage therapists work muscles only, and they haven't been trained deeply beyond that. This means that you might come in for a certain ache or pain and after the session, the same problem is still there. This doesn't mean that the therapist wasn't good or didn't do their job or work the right area, it means that it wasn't a muscle problem to begin with.

Let me clear up a myth, and this one has two parts: One is, you typically can't get every ache or pain completely worked out in one session. It's going to depend on a lot of factors, like how long you've had the problem, how bad it is, if it's inflamed or not (inflammation impairs healing), your overall health condition, how often you get massage, how long a massage you get, the skill level of your therapist (hint: don't go get corrective massage from Massage Envy after your rollover car wreck; seek someone with more experience), and more. I've had countless clients who come in and they want me to work every single area, deep and detailed, because it all hurts, and they only sign up for an hour. I can understand this if they don't know better, but after a session or two, it becomes apparent, and I'm talking here primarily to those who should know better. I'm not Wonderwoman and I can't possibly address every body part in a single session. If your neck has a chronic crick in it from sleeping wrong but you also want a full-body deep relaxation massage also, you're going to need a lot longer of a session than 1 hour.

The second part is, if you're in chronic pain or stress, you can't survive on one or two sessions a year. I had clients who, despite my best attempts at client education, I would only see them about every 6 months. Every time, they came in only when they were in enough pain that it started to affect not just their work life but their hobbies and sleep as well. If you haven't been in in a while, by the time I finish working on you, I've only begun to scratch the surface. There is a whole lot more follow-up bodywork (i.e. additional massage sessions) that needs to be done in order for us to actually make any progress. If you've got chronic issues, you probably actually need once a week, maybe more in the very beginning.

Next. let's talk pressure and deep tissue for a moment. First, don't judge a therapist's ability to go deep based on his or her size. Sure, it makes sense that the therapist who is also a bodybuilder can probably go a bit deeper than someone small, but don't bet the farm. And do not, by any means, make any assumptions based on the therapist's gender! Some of the smallest, thinnest female therapists can bring the biggest male clients to tears on a regular basis.

Second, there is no "no pain no gain" when it comes to massage. Get that myth out of your head, because it just makes you sound outdated...and wrong. Some of the gentlest techniques pack the most musculophysiological bang for the buck. Lymphatic drainage, gentle myofascial release, light pressure on a trigger point, Reiki, Cranio-sacral, etc, have all been known to work wonders for even the most chronic of problems. It's all about working smarter, not harder. Please don't be one of those strange people with something to prove (to themselves or the rest of the world) who have contests with themselves to see how deep a pressure they can take this time. It's not a contest. It's not the stock market, where it has to keep increasing to do any good. If it's doing you some good, it's doing you some good, even if the pressure is actually lighter than last time. Just go with it.

And on a sidenote, please don't be one of the occasional sick douchenozzles who don't think it's deep enough pressure unless they see the therapist squirming and hurting him- or herself in the process. I actually have heard stories of clients who didn't think it was good enough if their therapist wasn't struggling. I don't know what kind of sick psychological profile it takes to be that weird and pathetic, but I certainly refuse to work on that kind of client in my office. To those people: straighten up and be normal. Take your little fixations elsewhere. And please, adopt out any animals you have.

Now I'm going to talk about business and money, because to our un-credit, too many therapists are too chicken shit to do so, and some things need to be said. First, if your therapist is self-employed, it's OK not to tip. Tipping is appreciated by nearly all therapists, but seriously, they (should) have set their prices at a level they already think is fair and can live with. Tipping with me was always optional, but I felt uncomfortable for those I knew weren't made of money that felt an internal pressure to tip. Please, never feel pressured to tip me. I am seriously not going to think any less of you. I am spilling my guts in complete truth when I say that I would rather you save the money to use on future sessions (especially if money is an issue and you can't come in that often), or when I say that I would rather you talk me up to your friends and family and refer them in, instead of tipping.

That said, please understand that the tipping-optional rule is for self-employed therapists only. If they work at an establishment, chances are they keep less of what they make (due to mandatory overhead contributions or lower pay scales, and some establishments who pay MTs on a split percentage basis may require the therapist to take an even lower pay rate on a discounted massage, such as with a coupon or a special), and thus they'll depend more on tips than someone who is otherwise self-employed. Sure, one could argue that it's technically "their choice" to work at those places, but still - it may not be their first choice. They may have preferred to open their own business but perhaps they live in a location (neighborhood with strict zoning, or an apartment) that prohibits massage therapy (or running any home-based business, for that matter), and storefront flats are prohibitively expensive. So, if you have the money to frequent an establishment (which generally caters to those with greater means anyway due to their higher prices), please do the decent thing and tip them a little extra if you appreciate the service you received.

And please don't do the slimy thing and schedule a lower-priced Swedish massage and then once back in the room, request an advanced technique that would otherwise carry a higher pricetag. I had many a client try to pull this one when I was working at another massage establishment, and it only made them look trashy. The scenario went like this:

Receptionist: And would you like Swedish, Deep Tissue, or an advanced technique?
Client: Hmm...what's the difference?
Receptionist: Swedish is a basic relaxation, Deep Tissue is good for working out knots and going a little deeper into the muscles, and those are the 2 most popular. However, we also have Neuromuscular Therapy for targeted work, and Shiatsu and Pre-natal massage.
Client: Hmmm, OK...is there a price difference?
Receptionist: (states the prices, the Deep Tissue being only $10 more than Swedish, and any Advanced modality being $10 more than Deep Tissue)
Client: (hemming and hawing, and finally): I'll just stick with the Swedish.

Of course, I was around the corner, working on paperwork where I can't be seen. I heard the whole thing. I greeted the client and took them back to the treatment room.

Me: OK, so we're doing an hour-long Swedish relaxation massage today?
Client: Well, yes, but I need a little extra on my back, and I like firmer (read: deeper) pressure there, too.
Me: (now in the uncomfortable position of having to break it to them tactfully that they cannot get what they really want because that's not what they signed up for. Actually, it wasn't uncomfortable to have to do, it was just that I had to be ready for any of the various reactions that could arise from the truly special snowflakes as they went from semi-Jekyll to outright Hyde.) My biggest tip-off was when a male would sign up for a Swedish (yeah, right - most males wanted Deep Tissue and specified as much). In short, don't try this at home--or anywhere else.

Lastly, I want particularly my clients to know that I've had a lot of fun with y'all and that I do hope we cross paths again. After all, it's a small, small world.

(Stay tuned for an eventual Part 2, specially for those I call Massage Virgins)

A message to my peeps of the blue bird...

Hello, my bosom partners in music piracy crime, who partake in that lovely musical P2P program we all love and about which we keep mum. It is indeed Spitfyre, in case you're wondering. You're in the right place.

Guess what? After seven and a half faithful, glorious, uninterrupted years on Slsk, I am moving. I will be offline temporarily, for (quite?) a while, starting sometime after mid-December 2009. It may not happen until January or February (or even March, but probably not) of 2010, and once it does happen, I don't know how long it will last. Hopefully not long at all, as I will probably be going through more withdrawl from you than you will from me.

It's important to emphasize that this downtime is temporary! I am not permanently leaving Slsk. I will return, even if it takes a few months. Please be patient and keep me in your uselists and room memberships, public and private. I am coming back!

When I come back online, please keep a few things in mind...

First, please know that I currently live in a major metropolitan area where the broadband options are plentiful and reasonably priced. Up until now, you've enjoyed a decent upload speed from me (i.e. you downloading files from me), and my (cablemodem until May 2008 and DSL since May of 2008) connection has been very reliable. I am moving to a very rural country setting. I'm not kidding. If you pull into our future driveway, your cellphone signal will go into analog roam mode or disappear altogether. My only options will be dial-up, or various satellite options. Satellite options in the country suck, because they know they have you. I have to choose between a company that gives you good up- and download speeds but caps the overall data traffic for a certain 24-hour period (sure, you can exceed the cap, but then everything slows to a 1.0kb/sec crawl), and a company that gives you slammin' download speeds (i.e. me getting files from you) but uses a regular phone line for upload (you can get files from me but at crappy dial-up speeds--but you can get them anytime, because there is no daily cap). So, chances are that when I return, I will unfortunately be able to get files faster from you than you will from me. I hate that, but my only other alternative was to remain offline altogether and not be able to share OR receive files from other users for the several years that we will live there.

So, speed will suck and perhaps be less reliable, but whaddaya do? Another thing I'd like you to know is that when I return, my username will still be Spitfyre. Right now I have no plans to change that. I also plan to keep all of my shares exactly as they are. Everything you currently see, you will see again when I come back. My configuration will probably be the same unless I had a few folders and have to rename or reorganize a few things. In fact, I will probably share even more, as I may eventually have a few days on my hands to add more new downloads that I've been stockpiling (not due to greed or any other slimy reason, but sheer lack of time, as I have been in med school for the past several years).

When I come back, depending on which internet provider we end up signing up with, I may have to add some download restrictions. Let's face it: if I'm capped at a certain amount of up- or download bytes/megabytes per day, and I want as many people as possible to get fair access to music they want, I may have to limit users to something like 1 album per day. I am not yet sure if I will have to do this; time will tell. My current goal is to go with the service provider with the phone line upload but satellite download because even though it's totally not fair to you guys, at least I won't be capped and you can download music from me all day, and while it's pathetic speed, at least you'll be able to download an unlimited amount. Again, time will tell, and I'll post updates as I can.

Another idea I have is that we could end up putting the Slsk-based computer in our office, which will be in another major metropolitan area, instead of keeping it at home. If we go that route, we'll be able to take advantage of all the reasonably-priced broadband options that a major city offers, and thus when I sign back on to Slsk, your experience from then on will be much the same as you've experienced from me up till now: a reliable connection with decent speeds. The only drawback I can think of (and thus the only reason that this might not happen), besides my not having access to Slsk at night before bed or in the mornings before leaving the house, is that it could prove to be a distraction for us at the office (I'm very easily distracted), and we've got a business to start and get up and running, and savings accounts drain quick without income to replenish them. So, if we decide to keep the computer at the rural house, that's why.

I am unsure exactly how long I'll be offline. It could be as little as a couple days, maybe a week, or maybe as long as a month or two. Please know that I'll miss you all very much during that time, but also please keep in mind that I will be bouncing back as fast as possible, and in typical Spitfyre form.

However, true to form, my machine will remain online, uninterrupted, 24/7 for at least the next month or so, so feel free to dig in and have at it. By all means, get all you can in the next several weeks - but please do NOT queue up enough at once to crash my computer, and please DO have courtesy and consideration for other users, or I will have to open my can of flying monkeys to come after you in the night :)

25 CDs one should never be without - part 3

In no particular order (why start now?) ;)

1. The Verve - Urban Hymns (1997)
2. New Order - Low Life (1985)
3. Pearl Jam - Vs. (1993)
4. James Asher - Kali Thunder (2001)
5. Tragically Hip - Trouble At the Henhouse (1996)
6. Voice of the Beehive - Let It Bee (1988)
7. Pink Floyd - The Wall (1979)
8. Edie Brickell & the New Bohemians - Shooting Rubberbands At the Stars (1988)
9. Lazyboy - Lazyboy TV (2004)
10. Soda Stereo - Cancion Animal (1990)
11. Madonna - Ray of Light (1998)
12. John Mellencamp - Uh-Huh (1983)
13. Dousk - DIY (2005)
14. Enuff Z'Nuff - (self-titled) (1989)
15. 16 Horsepower - Sackcloth & Ashes (1995)
16. George Michael - Faith (1987)
17. Brian Burns - Heavy Weather (2004)
18. Cars - Heartbeat City (1984)
19. Sonic Youth - Washing Machine (1995)
20. Kaya Project - Elixir (2005)
21. Luscious Jackson - Natural Ingredients (1994)
22. REM - Green (1988)
23. Brooks & Dunn - Steers & Stripes (2001)
24. Jane's Addiction - Nothing's Shocking (1990)
25. Kitaro - Kojiki (1990)

Separating the wheat from the shafted

How pathetically ironic is it that someone born under the astrological sign whose logo is the depiction of a fair golden-haired maiden in tender guardianship of a basket brimming with freshly harvested wheat, has, after an entire life of peanut butter sandwiches, been relegated to the ranks of a population known as the "gluten-sensitive"? Somebody upstairs has a sick sense of humor. I had only heard the word "gluten" thrown around for the past couple of years (always at places like health food stores), and the term had always conjured images of an understandably worried mother and a physiologically hypersensitive child always on the verge of an asthma attack or skin rash who felt like a fringe society outcast because they couldn't have pizza like everyone else. As I scarfed down sandwich after sandwich of my own. Not realizing that every time I did so, I created a systemic inflammatory reaction, including inflammation in my brain. And, not understanding why no matter how much sleep I'd gotten the night before, no matter which types of tea or ginseng I took that morning, or how large a breakfast I had, I would still inexplicably "go away" in class.

I had no other way to describe it. I could feel it coming on at about the same time every morning and after self-experiment after self-experiment, nothing I did seemed change the fact that at certain times of the morning, I'd be mentally out of it, barely functional, a state that was completely involuntary. Professors had pointed me out a few times for falling asleep in class, because on the surface I appeared no different than the next slacker who was just bored, didn't care, or stayed up too late. Quite the contrary, underneath the apparent apathy was in fact an intense passion for learning the information that was being presented, and a matching frustration because I knew I was missing it. The information itself slipped through my fingers as fast as it had come in without being processed or committed to long-term memory, and there wasn't a damn thing I could do about it. Unbeknown to me, there was a battle raging on in my brain that left my brain cells so ravaged and traumatized it's a wonder they functioned at all. Despite getting decent grades, I absorbed very little, and committed even less to long-term memory.

Too late in the game to save my academic career but better late than never, I sought the help of a genius faculty doctor in our student clinic who ordered me a test kit that would run an entire panel of useful clinical indicators, including cortisol (adrenal stress hormone), insulin, IgA (an important immunoglobulin in the immune system for defending against foreign invaders), and gliadin (one of the measurable markers for gluten sensitivity). The best part was, I could complete the kit at home, drop it in the mail to the lab, and have the results back within a week.

The results were fairly predictable. My cortisol was too high (especially at certain times of the day), my insulin too low, my IgA fairly non-existent (no wonder I managed to pick up every bug from Austin to Oklahoma, despite my best efforts to take good care of myself and my recent new love affair with scented hand sanitizers and pre-foaming liquid soaps), and not surprisingly, my gliadin was high. My faculty doctor prescribed several basic medical-grade antioxidants and nutraceuticals (read: high-quality supplements and formulae, only available through certain licensed healthcare practitioners) to bring down the inflammatory load on my body and support crucial metabolic processes and help enhance the long road of systemic repair ahead of me. And, he outlined some dietary recommendations.

They were strict. No gluten or yeast. No alcohol, but I think I have that one licked. No soy, eggs, or dairy, either, but I'm still working on that. So far, I don't suspect a physiological reaction to those just yet, although this may change as I ferret out--and learn to recognize--various other responses I have to different foods. So, what this means is, no bread, rolls, pasta, pizza, cookies, cake, noodles, tortillas, sandwiches, hamburger buns, crackers, breakfast bars, etc. I even have to be careful with foods like soup or ice cream because they use wheat or gluten as a thickener. I have to be very careful with oats, considering my hit-and-miss history with even the Certified Organic variety. So, no more hamburgers, burritos, sandwiches, or even cereal.

Apparently, there is life after diagnosis. I'm new at this game, so I'll be discovering it and acclamating to it for a while. The changes have to be made overnight, but the adjustment takes time. I did my first gluten-free grocery shopping yesterday. This is infinitely easier to accomplish at health food stores. It's still kind of a bitch, because I still walk past all these foods that I'd still like to have. They sit there, on the shelves, taunting me. Shopping has become slightly more efficient, however, in that there are entire aisles that I can (read: have to) avoid altogether. This might actually be a blessing in (a very good) disguise, as I am now forced to branch out beyond my typical dietary staples and explore other options.

See, I'm not your typical Celiac Disease case. I don't get Baboon Ass if I encounter a molecule of gluten. For the record, my gastrointestinal tract never gave me any noticeable grief. I simply get sleepy (if I'm sitting), ditzy, and forgetful. My short-term memory gets pooched and I can't absorb or recall information. But I don't get nauseated or bloated or break out in any immediate rash or anything. That's why it took so long to start suspecting that it even posed a problem at all. But I'm convinced now that it's the missing link, because I cut it out completely and started noticing changes on that same day. Suddenly I could stay awake for an entire class hour. Not a week later, a friend commented on how much brighter my eyes looked, and she didn't even know about the gluten discovery. And by the way, I had (another) cold at the time (what else is new?) so by all rights, my eyes should've been anything but bright. But, the change speaks for itself. It's so simple really: remove the root cause of the problem and the problem will go away. By our very nature, we want to complicate the situation beyond that, but it really is that simple.

So now I'm part of this "gluten-free" population. Apparently, there are a lot of us. Thankfully, there is strength in numbers and the numbers of us are high enough to spark a market for gluten-free alternatives. We now warrant our own entire aisles of grocery stores, lined with foods pre-screened for gluten, which takes all the guesswork out of shopping. There are entire baking companies, cooking schools, and recipe-rich blog-based websites that can fill every void with cookies, cakes, breads, and waffle mixes that look and taste so good, you'd think it was the real (gluten) thing.

Note to the gluten-insensitive: we still hate you. You have it so much easier because it doesn't faze you. Your system will simply tear through it and process it like it was vegetables. You see, just because I can't have this stuff anymore doesn't mean I don't want it. Flour tortillas still smell really good, and I'd kill to ingest some freshly baked bread unscathed. But, the misdirected hostility dissipates, giving way to mere strong envy as time goes on, because it's getting easier and easier to survive and thrive, despite the hand genetic injustice we've been dealt. So many of us are this way, 30% and growing, that society itself is shifting. And maybe, just maybe (silver lining time), as my cells return to normal and their electrolyte ratios stabilize, they'll shed all the excess water weight they've been carrying. And that is something I won't miss.