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GERD: Treatment Options

GastrEsophagealRefluxDisease (GERD) is a very common problem that I treat everyday. I am posting a 20 minute talk that I gave at the YMCA last year. I had posted it previously; but, I had some technical difficulties and am redesigning the site slowly. In the past year there has been quite an emphasis on the most popular medication for the treatment of GERD, PPIs or Proton Pump Inhibitors such as Prilosec, Nexium, Protonix and Prevacid, and others. Alarming side effects have been reported; bone fracture secondary to impaired calcium absorption, chronic kidney disease, dementia, and aggravation of pulmonary conditions are examples. The data suggests that there may be some weak associations, and some of the alleged side effects have more data than others.
 
The primary goal is to control GERD with the least amount of medication. The reported side effects of the PPIs are dose-dependent, so a low-dosed PPI is much less significant than a high-dosed PPI. If medications do not work, or if a patient is dependent on high-dose PPIs, or a PPI-dependent younger patient, then surgical options could be explored.

 

Breast Cancer: a first conversation

I’ve been meaning to make this video for a long time, and finally got all the pieces together. I’m obviously not a video editor, but I’m learning. Feel free to share this with any family or friends who you know who are having, or have had a breast biopsy. This video would be good preparation for their appointment in regard to asking pertinent questions and more efficiently addressing their concerns.

If there are any other medical topics you think might be worth a similar treatment, let me know; and maybe I’ll get around to it :^l

A Story of Two Stone Pillars

We built our house in 2004, and towards the end I noticed a pallet of castle-rock, which we used on the front of our home, sitting on a bare patch of gravel. “What’s that for?” I asked.

“It’s leftovers, we’re going to take it away,” Paul (mason) said.

“Oh.” I looked at the gravel drive connecting to the road. “Did I already pay for it?”

“Yep, but we’ll credit your account.”

“You know, Paul. I think I’d like to keep it. I’m thinking of building some stone pillars out front some day.”

 

Night turned into day into night; spring into summer into fall; rain pelted, snow fell, hail hammered; ten revolutions, earth made around Sol as it spun silently, hurtling through the frozen vacuum of space, a pale blue dot of so much significance, and yet, so little:–and through it all, through all the wars and famine and strife the pallet of castle-rock weathered all until one happy day, the sixth of August, 2014 it became this:

Stone pillars

 

 

I tried, two times, to contract a mason to make these pillars over the previous years, but found no takers, not even a bid. After my experience last summer, previously documented in prior posts, I figured I’d do it my damn self. I actually like the mason stuff, at least, I think I do because if I didn’t I’m thinking I’d actually try harder to find someone to do it for me because, given the amount of time it takes me, it would be much more economical for me to do more of what I do and use income from that to hire someone to do what they do because they could most certainly do it quicker for less.

I created an account on Pinterest and looked at scads of pictures of stone pillars, and then, while in the Garden Center at Menards one day, I saw a dry-stacked, Belgian stone, lighted glass-block topped pillar;  and, I thought, I can certainly do this; except, that I would use the castle-rock. First, I needed a foundation around the electrical. I dug down until I hit rock, and roots, which in Door County, where I live, is something less than 12″. I used concrete blocks, ready mixed concrete and quarry wash. On top of the foundation I built a 16″ square of more concrete blocks, filled with concrete and rebar except for one of the four hollow tubes (for the wire). Then, I raised the castle-rock around the core and back-filled with rock and more mortar.

 

I had a live wire to the pillar on the right, and also a run under the pavement to the contralateral pillar; so I wired a GFI outlet to the pillar with the live wire and ran the power through the conduit into the open core to the dusk-to-dawn sensor. I wired both lights then to the sensor which I had mounted inside the fixture so I didn’t have to drill through the stone for an exterior exposure, which seemed to make a lot of sense initially.

Electrical into outlet, out to sensor, out to lights.

Electrical into outlet, out to sensor, out to lights.

However; when dusk came, the lights went on, then they went off, then they went on…

I then realized that the switch sensed the light source and turned off, then with the decrease in ambient light turned on again, and repeated, ad-infinitum like a slow-motion strobe. I still didn’t want to drill a hole through the stone and in the spirit of the pen being mightier than the sword, i. e. the mind greater than the rotary stone drill, I shined my my not inconsiderable intellect into the darkness of my oversight and deduced that the light sensor was activated by photons, whether those photons came from Sol or my light did not matter; so, I only wanted it to receive photons from Sol. Therefore, I surmised, I could point said sensor away from the light source, towards an inside corner, painted black (non-reflective surface) and the photons would be absorbed as heat and not trigger the sensor.

Did it work?

Well, the lights are on.

IMG_2081

 

I am glad they’re done. And when I come home late at night, I get to drive through these :^)

Besides, I’ve got another two months of stone paths around a pond, and a stone arch–moon wall, I’ve been meaning to build; and, I’m only down three toe-nails and the right middle finger, still black, have yet to shed them.

Swimming to Saba

The other day I picked up the Peninsula Pulse laying on my coffee table and discovered that I had received an honorable mention for The Wisconsin People & Ideas 2014 Fiction Contest. I vaguely remember sending in a story a few days before the deadline; a story I’d actually submitted to the annual fiction contest at the Pulse except that I blew a little dust off it and added about 500, apparently significant, words. I remember submitting a story in 2010 that I had written while convalescing from a self-induced injury. That story was about the 12th Imam; this one was a love story, more or less. If you’ve navigated to the link, you’ll see my honorable mention, the first of five, in small print below the pictures of the winners. I appreciate the efforts of The Wisconsin Academy of Sciences, Arts & Letters; still, my effort at the writing of Swimming to Saba remains yet another unread story, which isn’t necessarily a bad thing, depending on ones perspective. That is, until now. I thought I’d post it for the hand full of readers that might stumble across it, perhaps searching for the location of the island of Saba, or maybe searching for ways to improve their swimming or what to do in Saba; but, certainly not by searching for fiction by shaun melarvie–of that I am certain.

Here’s the pdf file: Swimming to Saba 4.

 

How to view multiple TVs with one cable set top box

May 6th, Charter TV will be going all digital, which I initially thought to be good news; but, then I was informed that every TV I had would need to have a set top box attached to it. Now, if I had 2 or maybe 3 TVs I suppose I could stomach that, even at $7 a month per set top box after that first one, or maybe there is a fee for that as well, I’m not sure. The same situation exists for satellite TV (I checked), every TV needs a receiver, and for Directv that is $6/month/TV.

I was told that the good news was that I could record six different programs while watching multiple different channels, all at the same time! Wow! Maybe if I didn’t have a life, or was a trust fund baby, or an unemployed college graduate living in my parents basement, maybe then I might have occasion to do as much. As it is, the reality is that in my house there might be a handful of times during the year (when company comes) that there are two different TVs on, on two different channels; and, I have never recorded anything yet.

So this is what I did for less than $20. This is pretty simple, and I’m sure many others are already doing it.

Givens:

The cable coming into your home has to be split among all of your TVs;

Every TV must have the signal de-encrypted by a set top box; (so they tell me, when it does happen, I’m still going to hook my tv up to the raw cable and run an auto-program to see what happens). I admit that I am frustrated by the disincentive to allow you to realize the least expensive solution.

Every cable coming out (output) has to be going somewhere (input);

 

What you identify:

What TVs do I want the capability to surf channels on, check the guide, maybe DVR something, etc.;

What TVs do I want to just turn on and watch a preset channel (like Fox News);

How many TVs will be used to watch different channels at the same time; this will be the minimum number of set top boxes you will need. In my home, that number is one.

 

What you need:

A coaxial powered splitter of which ever number of set top boxes you might want; I bought a 1:4 powered splitter from Radio Shack for $15. Something like this one.

3-5 extra coaxial cables of 3-6ft length;

 

What you want to do:

You are going to share one set top box among all the TVs in your house you want preset to one channel. If you only want one channel at one time, you only need one set top box.

The cable company has already hooked all of your TVs up to a distribution hub of some sort that splits the signals to the cable runs in your home supplying your TVs. Their solution is to put a set top box at the end of each cable run for each TV, at $7/box/mo.

My solution is:

Put one set top box at the front end of the cable run (figuratively) by connecting the cable (TV, not internet) coming from your modem to the input of the powered splitter. You now have four amplified signals to use. I have a distribution hub already that has five inputs and 16 outputs. You should have some sort of a splitter or hub that all your TVs are connected to.

Connect a cable from one of the outputs of the powered splitter to the input the cable set top box. [You need to get a set top box that has a coaxial output (it should have a HDMI too)] Then connect a cable from the coaxial RF out to the input of the hub that supplies all of your TVs in the house. Now, all of your TVs are operating off of that one set top box.

You still have three left over powered outputs; so you can take up to 3 TVs off the distribution hub for all the TVs and connect it to the raw signal in front of the first set top box and use your second and third set top boxes at the other end of the cable run, between the wall plate and television set. In my case, I only have one other.

I have a home theater that I have a set top box for, and my other box controls all the other television in my home.

The only problem now is how to avoid going to your distribution hub in the basement or attic to change channels:

There are two solutions I thought of:

1) If you have two cable runs going to a TV on the main floor (this is what I did); you can simply move the box up by outputting the signal from the powered splitter into the cable going up to the room (wall plate), then connecting that to the cable to the input on the set top box, and then outputting (RF out) back down the other cable run and connecting that to the input for the distribution hub for all the other TVs. As I mentioned earlier, the set top box also has an HDMI output, and you can connect this to your TV. My set top box will deliver signal to all outputs simultaneously (although I’m sure they will change this if too many circumvent the need for multiple set top boxes as I’m describing here). So, anyway, when I change the channel in my living room, it changes the channel for all of the televisions in my house except for the one separated out by the powered splitter that goes to the home theater.

If you don’t have two cable runs, and you have an attic or an unfinished basement, it would not be a big deal to run an extra cable.

2) If a second cable run is not an option, than you could use a wireless remote control extender kit like this one here, or something similar.

If you want to control channels in more rooms, you can do so by buying additional transmitters for the IR remote extender receiver that is by the shared set top box (controlling it).

I think its actually pretty convenient. All the common TVs are preset to channel 3, so all you do is turn it on and turn it off and control the volume. If you’re watching a program on one of the shared/common TVs and move to another room, all you do is turn the one TV off and the other one on.

Good Luck.