Category Archives: Advice

Immunotherapy PSA: Stay the whole thirty minutes

Hi, I’m Sam. Do you know what immunotherapy is? Have you seen The Princess Bride? If you answered no to the latter, go watch The Princess Bride and come back. Do not use this brief recap as an excuse to not watch the film in its entirety. To do such a thing would be inconceivable. That’s another PSA for free, folks.

Not included in the above video is the Man in Black’s explanation for why he won the battle of wits despite Vizzini’s ruse. In the next scene he tells the princess that, in fact, both cups were poisoned. The Man in Black has protected himself from the poison through mithridatism, building up an immunity by administering very small doses that increase over a span of time.

This is the same concept behind immunotherapy. After developing a solution of the allergens to which you would like to become immune, your allergist will inject heavily diluted doses directly into your bloodstream once or twice a week and slowly increase the intensity over time. You may be thinking that this sounds dangerous. Or maybe you aren’t.

Well, actually, the reason it’s not particularly dangerous is that the doctors know what they’re doing. Certainly The Man in Black doesn’t mind taking his life into his own hands, but your doctor would very much prefer that you do not. Doses are administered according to a strict regimen, typically requiring a complete restart if you so much as move to another doctor. What’s more, the most time-consuming part of the process is actually just thirty minutes of sitting in the waiting room to see if you have a reaction.

This is where I come in. After a few months of twice-weekly doses, I had never had more than a red bump that felt like a bee sting. I never left the office before the nurse came to observe my reaction, but that was more of a sense of habit and respect for doctors than an actual sense that I was in any danger. Last Thursday, it all changed.

Ten minutes after my shot, I was itching all over. Then I started sneezing and coughing and my eyes started to water. In moments I was wheezing to the receptionist, “I think I might be having a reaction.” Then I was surrounded by medical professionals who insisted on wheeling me through the health care center in a chair regardless of whether I  myself felt I was fit to walk.

I felt pretty much fine through all this. If that seems strange, note that I have experienced each of these symptoms individually and at no point had any of them been life threatening. So, when the nurses told me not to be afraid and I wouldn’t die, I said “why should I be afraid I’m going to die?” I wonder if the fact that I was shaking like a jackhammer from being given three epinephrine* shots had anything to do with the seeming over-concern over my emotional state.

It was when I was feeling pretty much great that they decided I should go to the emergency room. They said that I needed four to six more hours of observation, and even the length of an Uber ride to Rex hospital without professionals staring straight at me could be fatal. So I obediently climbed into a surprisingly comfortable gurney and enjoyed the comedy stylings of my EMT, who told me that I was shaking like a dog pooping razor blades and that he was going to steal my identity through my digital signature.

Wheeled to my room, I climbed out of the gurney and lay on a substantially less comfortable hospital bed. A nurse pumped me full of Benadryl, and left me in the room unobserved. I sat semi-catatonic on the bed for an hour and then another nurse came in to give me a prednisone prescription and tell me I was free to go. I took a Lyft back to my house, then drove to Harris Teeter to buy some pork ribs and kale for supper.

Three morals I want you to draw from this experience:

  1. Don’t wander off when you should be under observation during an immunotherapy shot.
  2. Sometimes healthcare practitioners in an ER have a very different idea of how much danger a patient is in than their peers in a company health care center.
  3. You should watch The Princess Bride

This has been a public service announcement.

*also known as adrenaline


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Happiness is a skill

When people say they choose not to worry or they choose to be happy, I think it’s misleading. It trivializes the difficulties many people have with happiness. On the other hand, with some exceptions, I also have trouble believing that happiness is an innate talent inert to efforts to cultivate it.

I consider happiness like a skill. It’s very common for people to confuse skills with innate talents, just consider the last time someone told you they “can’t do art” or said how lucky you were that you could do math. It’s less common to hear people going the other way – telling each other to “be better” at something as if for some inscrutable reason they simply hadn’t considered the possibility of having skill, but I can admit that at times I have been tempted to say things like that.

There are a number of external factors that make happiness easier.

  • Low stress
  • Strong social support
  • Natural light

There are also actions we can take that tend to make us happier.

  • Regular sleep
  • Exercise
  • Diet

None of these are exactly building up happiness like a skill, though. They are indirect practices – like lifting weights to be better at wrestling. However, I have a personal approach to mindfulness that is, in my personal experience, the practice of happiness. To practice happiness, at any time of day, whatever you’re doing, take your attention and see if it’s on something making you happy. If there’s anything about what you’re doing that makes you happy, train your attention on that. Practice forgetting what upsets you and thinking instead about what makes you happy.

For instance, if your friends upset you, consider what has led them to make the upsetting decision and how good you will feel if you can rise above it. Think about how much you like your friends and how much better your relationship will be if you handle this situation well. If it’s hard in the moment, try to remember something in the past you liked about them. If your work is frustrating, think about the people you’re helping or think about the money you’re making, or even just focus on doing your job as well as you can. You’ll be surprised how hard all this can be, but if you keep at it, you may be surprised by how much it can help.

For more thoughts on depression and dealing with it, see the excellent blog by my friend Laura –

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Sam’s Guide to Swimming

Swimming is an art form just like competitive street polo and professional Hungry Hungry Hippos. It is relatively quick to pick up, but mastering it takes a lifetime.

When swimming, if you find that you tend to sink to the bottom of the pool easily, not to worry. It is simply that you are heavy. No, you’re not fat. You’re just dense. No, not stupid, just, well, never mind.

In ancient prehistory, our ancestors were the ultimate endurance swimmers. We would swim for miles chasing the large fish that once inhabited the African ocean until they’d eventually become exhausted and be unable to continue to flee. Modern humans have fish delivered to their doorsteps already killed and cooked, and they no longer use these skills, but they lay dormant in all of us. One day in the near future the carbon generated by our fish delivery systems will heat the atmosphere to the point that the icecaps melt and the entire world will be one great African Ocean, and the people that survive will be the ones who can best return to these ancient practices. Kurt Vonnegut agrees with me.

In a modern pool, one of the most important secrets to swimming faster is to be able to turn around quickly when one reaches the wall. The commonly accepted technique to deal with this is the flip turn. Here is a professional performing a flip turn. Be wary, though, pool walls are something humans never dealt with during our evolution, and thus can be very dangerous. As an amateur, you should be sure to have someone nearby to resuscitate you when water gets in your nose and you drown. With practice, you will learn to stay conscious long enough to get to the surface and clear your nose of water to breathe again. Good safety practices have dramatically reduced the high death rate from flip turns in the history of the sport of swimming.

In this modern era, it is tempting to sit on your couch and have cooked fish delivered to your door. Remember that you can take better care of yourself if you drive to the supermarket to buy fish and cook it yourself with only a small amount of added oil and salt. Swimming in a pool is also good for your health, once you have mastered the technique of not dying. So get out there and swim!

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Evolution and Dogs

My friend Jim has a dog, Casper. Casper (pictured above) is a six year old American Eskimo Dog who still has the energy of a puppy. This is not entirely an accident. Jim is a researcher at a local company, and he has made research into a way of life. His research when selecting dog breeds led him to the discovery that a dog’s lifespan and general health is closely related to how much the dog looks like a wolf.

If this seems surprising to you, consider this: each breed of dog is a descendant of wolves. The breeds were then created through, well, breeding. Humans selected features they wanted, and the very wolf-like first dogs led to dogs optimized to be small (toy breeds), or have comically short legs (Corgies), or short snouts (pugs). In this optimization for human-selected qualities, they have been optimized away from survivability, that is, health. This can also happen with plants, leading to unfortunate situations such as illustrated in the comic below.

There are some things that have not been bred out of dogs, though. For instance, the predilection to roll in the leavings of other animals. Some study has been devoted to this behavior. Theories of why it might be beneficial for a wolf to roll in poop or a rotting carcass include camouflage and group identity.

The camouflage theory does not apply to fooling prey so much. A study of wolves given various scents to roll in found some interesting results.

Surprisingly, the wolves were least interested in rubbing themselves in the faeces of herbivores like sheep or horse: the scientists did not see them rub at all on these odours. Food was similarly unappealing. Instead, their favoured scents were artificial odours like perfume or motor oil.

A powerful, strange smell like perfume is likely to make hunting more rather than less difficult. A savvy prey will run from any strange smell approaching. A predator, however, is more discerning. It may be less inclined to pick off a delicious straggler from a pack of wolves if its nose tells it that in fact what it smells passing by is merely a pack of poops or an ambulatory puddle of motor oil.

Group identity is even more fun. All the wolves in a group might roll in the same dung, identifying themselves together as “team bear poop.” Team bear poop then can more effectively work together and compete against “team deer carcass” and “team industrial sludge.”

I wonder if a dog who finds a scent it likes may just want to keep it around a little longer. What better way than to make it a personal perfume? So, the next time your dog chooses to express its membership in “team ruptured septic tank,” consider giving it human perfume after you wash it for a more sanitary Eau de Toilette.

Asymmetric Information in D&D

The key element of a Dungeons and Dragons game is the party. Seldom does a dungeon master run an entire campaign for just one person. A cooperative group of players is central to the game since its founding, and is so entrenched that when a player doesn’t want to cooperate, things can go very badly even outside the game itself.

But that can make for a dull story. Imagine if the Lord of the Rings had no Boromir, a friend turned foe by the evil power of the One Ring only to be later redeemed. NPCs can serve this purpose handily, but it’s harder to get player characters to change alliances and fight with one another.

One issue is well-defined moral dichotomy, which to some extent I have already discussed. Another part of the matter is that information is necessarily shared between all players. If the dungeon master tells a player what his or her character is seeing, all players hear. When crowded around a small game table, inconspicuously getting around this may be easier said than done.

It’s not impossible, though. If you pass a note to a player, other players will see that you’ve passed a note, but not the contents. If you write a text message, they will hear the ‘ping,’ but won’t know what has been communicated. These are only good for simple messages, as few players are willing to wait while their DM types out a page of details on his or her phone.

For more in-depth privileged communication, I recommend what I refer to as a “Special Session.” A special session is a session of a campaign devoted entirely to one member of a party. Generally this can happen while the other party members are asleep or after another excuse to split one player off. I have run special sessions in person and on Google Docs, exchanging DM descriptions and player actions in text rather than through speech. In the latter case it can even take place over a number of days, although it must end before the regular party comes together again, or the story might not be able to accommodate the separated player participating with the rest of the group.

I have tried a few of these methods with exciting results. For one example, I have a druid in my party who can understand spider talk, so I send him texts of everything the spiders around his druid are saying. Colleen elected to tell none of her friends what her arachnid friends were telling her, much to the rest of the party’s chagrin. Another character had a midnight meeting with an NPC who begged permission to kill another NPC party member, a zombie, whose very existence she felt was against her God Pelor. This led to a dramatic, improvised sequence in which the party debated whether to kill the ostensibly friendly zombie, and eventually Tom the Monk succeeded in converting the zombie to himself be a follower of Pelor. This substantially changed the plot going forward onto a track that I had not previously considered. A third pious character received a message from his god during prayer (an email from me) and spoke in elaborate fantasy detail of his experience of the message to the other party members. Other private communications are still playing out. Some of my players read this blog, so I won’t go into detail.

To be fair, I should note that some dungeon masters would prefer to avoid rather than encourage party infighting. for some groups it will ruin the evening. In my case so far people are enjoying the special attention that they receive as part of getting privileged knowledge. I am enjoying seeing what they do with it. I cannot recommend strongly enough to any DMs looking to add more spice to a D&D game that they should try and add some information asymmetry. It’s well worth the effort.

Friends don’t let friends get the Windows phone

So I know this guy. He’s older and he’s got some vision troubles, so he doesn’t drive at night. I take him to a game party one time and he asks me if I could help him install Uber on his phone. I think “well, this shouldn’t be so hard,” and accept the phone. If you read the title, you’ll see what’s coming. It was a Windows phone. The first I see, the app is already installed, but I don’t see it. I try to search for it using the search feature, but, of course, that goes straight to Bing to search the web. I scroll down to look for it and find it under the old logo. I don’t know how old. I move the app up to the top and make it full size so it’s easy to find. Then I open it and see I just needed to create an account. So I do. He gives me his information and a password and I enter it all and find out that his email is taken. He already has an account. That’s easy, I’ll just reset the password. Turns out he has an AOL address. So I send the password reset to his AOL address.

One problem, and this is where it starts to get weird, AOL mail doesn’t work on his phone’s old Internet Explorer app. So, I have to borrow a friend’s computer to log into his email and get the reset password. Fine. That works. Now it wants me to enter the four-digit passcode it sent to his phone in a text. Cool. I wander around on the phone trying to find out where the texting app is. I find the chat app, full of spambots posing as women making lewd comments. I try the search feature and it takes me to Bing again and searches the web for “text.” Finally I find the text app by manually scrolling through the tesselation of little square icons that makes up the Windows home screen. Nothing. I wait. Still nothing. I try resending the text. There it is. I input the four-digit code. “Error” says the screen. I resend the code and enter it again. “Error.” I resend and enter the code a third time. Success. We’re logged in.

So, I register his financial information. Error. I ask for his financial information again to register it once more. Error. I try a third time. Error. I back out. The information is registered and ready for use. The map looks like the Uber I’m used to, but all of the text looks like it’s been replaced by incomprehensible ads. Instead of “call Uber” it says “call hurricanes.” The label pointing to our current location says “check back for offers.” Fine. I know what it all means anyway. I tap the “call hurricanes” button. I set the destination and, just to show how much it usually costs, I tap the “estimate fare” button. “‘estimate fare’ is not available for hurricanes.” Fine. He’s ready to leave the party, so I order him a “Hurricane.” “Searching for your driver.” This screen stays up a long time. So long, in fact, that my other friends are getting impatient for me to join them in the game. A friend who isn’t playing volunteers to watch the searching screen. Once I pick up my cards, she comes to me and says a message came up, but it was too fast to read, and now we were back on the Uber home screen. I try pressing “call Hurricane” again, and this time we get a driver. The good news? He shows up and takes my friend home. Everyone at the party breathes a sigh of relief as the car finally drives away.

Please, if you know someone who is looking for a phone, don’t let them get a Windows phone. It’s not kind to anyone. This has been a public service announcement.

Informal Qualitative Personal Psychometrics

Two of my co-workers took an energy management class recently. I happened to join them the other day when they went to meet with some of their former classmates. It was a lunch meeting, so I had my usual salad. The people at the table who had not seen this before were aghast that I was eating what amounted to kale, spinach, lettuce, and carrots with no dressing whatsoever.

Without time to think of a better answer, I said “dressing is superfluous.” A little later I brought up the conversation again. I said I had considered a while ago what it was that made me reluctant to eat salad. The inconvenience of fast-decaying greens made it difficult in my house, but at my work the high quality salad bar resolved that issue. As I mentioned in last week’s post, eating in and of itself is a calming activity for me. Salad greens and carrots, I learned, were not outright unpleasant to eat so much as just boring. Therefore with an interesting main dish, a large salad is a perfectly acceptable side. I do not trust salad dressing as a regular part of my meals. In general, it’s a highly processed vector of salt, sugar, and other mysterious chemicals to wreck an otherwise healthful salad. The fat in dressing is supposed to be helpful for properly digesting salad nutrients. My mother is a public health researcher, and after a very long conversation that I had to repeatedly bring back on track when she reacted with horror to every hypothetical food I suggested as an example of the non-salad parts of my meals, I managed to get her to agree that if I am eating something fatty elsewhere in the meal there is no need for additional fat directly on the salad.

When I said this, one of my co-workers immediately identified it. “Psychometrics,” he pronounced. “You are using psychometrics.” I found this characterization amusing. I would normally refer to this as introspection, but it may also be reasonable to think if it as a sort of informal, qualitative, personal psychometrics, or IQPP. Just kidding. I’m going to refer to it as introspection.

One of the first IQPP introspection-based lifestyle improvements I’ve made surrounding food in particular has been to recognize the pace at which I cease to enjoy a food. I have long been aware that my second bite of ice cream is not as good as my first, and that by the time I get to the bottom of a large soda I am either hardly noticing the flavor anymore or actively feeling sick. Selling food in small quantities is not something that capitalism encourages. The economy of scale and simple matters of supply and demand mean that the more food companies can get you to eat, the more money they’ll make, even with extremely steep bulk discounts. At my work, I have an unlimited supply of free lemonade and every week we have our aluminum cylinder of peanut M&Ms refilled. It lasts about two days on average. This resolves the issue of purchase volume as I am free to commit myself to no more than one M&M at a time. All that remains is self-control. By focusing my attention on the diminishing pleasure achieved by each additional peanut M&M, I have resolved the age old paradox, “you can’t eat just one.” I also use the roughly quarter-cup plastic container given for these snacks when I feel like I want some lemonade. A sporadic single peanut M&M and a quarter cup of lemonade now and then maximize my pleasure-to-sugar ratio when I might otherwise be distracted by temptation or feel sick from overindulgence.

With Halloween nearly two weeks past now, we’re still receiving bags of candy in our break rooms. After helping myself to four pieces of candy, I decided it was time to stop. This did not relieve me of temptation, though. Introspection to the rescue! Shortly after picking up a full-size bag of sour skittles, I analyzed my response to it. Without even opening the bag, I was already enjoying the experience. The crinkling of the gaudily colored packaging paper and the feel of the rough sour crystal-coated skittles inside served as the lead-in to the eventual experience of eating this snack. I decided to try treating it as the entire experience, and walked back to the break room to put down the bag of skittles.

Another treat from my childhood, Nerds, is a small, tangy candy that comes by the hundred in colorful little cardboard boxes. Lifting one of these boxes in my break room, I felt and heard the candies jostling and bouncing around. This was part of the experience, no doubt like the skittles carefully designed to keep people coming back and filling up on more sugar. Again, I was able to make it the whole experience. Every single time I saw that particular box of Nerds I picked it up and tilted it, remembering the joy I had received from others like it as a small child while suffering none of the consequences of adding so much sugar to my diet.

Do any of my readers have healthy eating strategies? Share in the comments.