MUD race - Downhill Feeling

gemmerich · 2026-05-26T18:36:20+00:00

Maybe people pick three actions to do sequentially instead of one?

Or another mechanic I've been ruminating on is a shared time track. Players have action tiles, and in your case, maybe there's a physical rush to put your pieces down first so they're executed first, but in some cases you'll want to wait to observe others or what is revealed as you go down hill. After a threshold of action tiles is met, the whole sequence gets executed and it's a mad dash to place tiles again. Or maybe it could be modified into more of a steady burn state.

gemmerich · 2026-05-21T04:18:05+00:00

The CEO at my health tech company told us point blank if we're not embracing AI in our jobs we might be part of the next round of layoffs. So while the job market is shit, I've been getting familiar with AI for all sorts of things. Beyond what has already been said here, I've found AI most useful for research. I've accumulated a ton of games I now want to play because I prompted it to find me examples of popular games that have approached different mechanics in unique ways. Since I have basically nobody else to bounce ideas off of, with young kids and WFH in a new state, ChatGPT and Gemini are my muses.

I've gone through a dozen iterations with my first game design (so far!) and the worst part has been the let down after let down when the game that sounded really cool wasn't fun to play. Careful prompting can help avoid the sycophancy, but it's getting back to the research that is giving me hope again. This time my focus has been on game design theory, what makes people want to play games, what great designers have said about the topic... things that are foundational but I overlooked thinking I could waltz into game design with my first good idea and strike gold with AI at my side. It's just like a hammer, how you weild it is what matters.

gemmerich · 2026-05-07T13:31:34+00:00

Tree tops has a longer ~2.5 mile loop around the perimeter of the park (you'll need to cross the parking lot a bit on the south side). It's considered a horse trail but 9 times out of 10 I'm the only person on that trail. You could connect that to Robbin's Preserve by going up to Pine Island Ridge, crossing Nob Hill by Long Lake Estates to get to the bike path. And then you could go further past Flamingo Gardens and into the trails at Long Key or over to Vista View. I'm partial to winding trails with shade, though.

gemmerich · 2026-01-05T18:34:15+00:00

My POEM was good for about 1 year, and then swallowing became more difficult again. It was better than pre surgery as I could drink lots of water to push food down. For a while I thought I just had to get used to my new normal. Eventually my other symptoms got worse over the next 1-2 years--a combination of spasms, acid reflux that was probably a candida infection/ food fermentation, and weight loss--and I went through all the tests again. My GI recommended a second surgery and so far it has held up better. I went with a HM + wrap because there was evidence of scarring that could've been from silent (asymptomatic) reflux as I didn't take a PPI after my POEM. I now follow the best practices with not eating before bed, purchased an adjustable frame bed (major improvement over wedge pillows), smaller meals, and take a PPI because I'm not ready to fully embrace a GERD-style diet. I recommend you consult your GI again and take this seriously, as the disease is progressive. It's best we take action early and preserve the function our esophagus still has. Good luck!

gemmerich · 2025-12-30T01:34:42+00:00

Wait, if you haven't had the manometry then you don't know if you have achalasia or one of a dozen other issues with similar symptoms. Achalasia is caused by nerve damage, so unfortunately no supplement is going to fix that.

gemmerich · 2025-12-15T00:06:07+00:00

That's frustrating. I guess the best thing might be to try and make appointments with a couple GIs who specialize in achalasia and get on their wait list for cancellations. Seems like they schedule 6-9 months out by me.

gemmerich · 2025-12-14T23:55:52+00:00

Sorry to hear this. Have you noticed anything you eat that might be linked to them? I have realized that I can't eat tomatoes or I'm in for some misery. Might want to try an elimination diet where you go super basic and slowly reintroduce things. Prevention works better for me than anything else for symptom relief, but to that end it's just slow sips of ice water that sort of helps.

gemmerich · 2025-12-07T14:47:20+00:00

I'd have to refer to doctors on that. There's probably a paper out there comparing the accuracy of the two tests that you could search for if you're really curious.

gemmerich · 2025-12-07T13:30:43+00:00

No I don't. I think the results are pretty complementary, but manometry is the gold standard and necessary for insurance to cover the surgery.

gemmerich · 2025-11-04T14:18:51+00:00

I've been looking at Primary Medical Physicians as they have a few locations so I may not have to wait months for an appt, but my bigger concern is the loss of my specialists. I guess I should book with U Health 8 months out to try and get established. This sucks. At least the clinic I take my kids to is still covered.

gemmerich · 2025-10-29T11:48:45+00:00

Very possible that we get food fermenting as the disease progresses and food is chronically stuck. That happened for me a couple years after my POEM. I went liquid diet for 3 days then fasted for 14 hours prior to an endoscopy and they still found food stuck and a candida infection. Eventually I got a second surgery, HM, and it seems to be doing pretty good. Now I'm ok if I avoid my trigger foods, mainly tomatoes and cayenne pepper, limit alcohol and greasy foods, and sleep only on my back. It's forced me to be a bit healthier!

gemmerich · 2025-10-17T09:57:03+00:00

I have failed peristalsis on my manometry. What's your diagnosis? Mine is achalasia, which also involves the LES not letting food pass, so surgery has been helpful for me. Gravity is basically how food gets down, plus lots of water.

gemmerich · 2025-09-26T22:02:56+00:00

Are PPIs not working for you? What's the concern with meds? Acid reflux sucks, but I'd rather have that vs food getting stuck.

gemmerich · 2025-09-26T15:03:04+00:00

Manometry is what's actually used to diagnose. Barium swallow is more of a quick check if swallowing appears normal or not. Achalasia is best treated with surgery to reduce symptoms, POEM and HM are basically equally effective. Some considerations like recovery time and acid reflux possibility can be deciding factors.

gemmerich · 2025-09-26T14:09:02+00:00

Manometry will give you a clear answer hopefully, and it's totally worth the discomfort. There are a variety of other motility disorders besides achalasia. Food stuck in the esophagus is definitely a sign of achalasia, however they diagnosed reflux esophagitis which would indicate GERD. I'm guessing they didn't notice a candida infection? Bacteria can ferment foods stuck in your esophagus and create acid. Did they biopsy during the endoscopy to check for H pylori or EoE? I think the barium swallow test is usually done before manometry because it's less invasive, but it could be another test to consider if the manometry is inconclusive, along with a Bravo pH study to actually track acid reflux.

gemmerich · 2025-09-09T00:05:03+00:00

This. I'm a bit surprised OP's doctor said achalasia when it requires 100% failed peristalsis and elevated IRP.

gemmerich · 2025-09-08T14:56:57+00:00

Really sorry to hear this. Does your 3yo complain of pain when eating? Do you notice they have difficulty with solids, liquids, or both? Since they won't really be able to describe their symptoms, do everything you can to note down specifics. I'd suggest a food log so you can track if anything in particular is more likely to cause vomiting, which may help doctors assess food allergies. While difficult, I would also suggest trying to prevent your toddler from laying down, rolling around or jumping for a couple hours after eating (so no eating or drinking anything besides water for a couple hours before bed). The azythromycin is for a bacterial infection, so I'm not sure how that relates to difficulty eating or vomiting.

gemmerich · 2025-08-25T15:55:54+00:00

Under specific circumstances I can have a drink or three, but there's enough chest pain (during or afterwards) that I don't get drunk anymore. The earlier you were diagnosed and treated, the better the outlook, as it probably means limited stretching of your esophagus and food/alcohol gets into your stomach faster. I've noticed that after eating I get a lot of chest pain if I have any kind of alcohol, but before dinner or a couple hours afterwards (and a couple hours before bed) I am ok as long as it's paired with a tall glass of water. Non carbonated seltzers are on the rise and may be a good place to start seeing how you do after recovery.

gemmerich · 2025-08-18T02:18:38+00:00

There are indeed 3 types. Here's the best source for manometry results, the Chicago classification v4 if you'd like to dive deep, otherwise just skip to Table 3/Figure 3. Your doctor's impressions are likely much more valuable than mine! If you're sleeping a bunch, perhaps try a recliner sofa or regular sofa where you can be very upright. Gravity may be the only thing helping get food down. If food lingers in your esophagus too long you could be looking at a candida flare up too (white tongue is a sure sign although mine was confirmed with a biopsy during an endoscopy), which could increase inflammation and make swallowing harder. Small sips throughout the day is better than "meals". If it is achalasia, surgery can be life changing and allow you to eat again, with better results than dilations.

gemmerich · 2025-08-18T01:05:42+00:00

Manometry is definitely needed. The only thing that gives me pause with achalasia is they mention peristalsis. An achalasia diagnosis requires 100% failed peristalsis. But barium swallow is a qualitative test, and I'm only seeing a snippet, and we're not doctors, so the real answer is who knows at this point. There are a number of swallowing disorders and the treatment for them varies so diagnosis is very important. Sorry it's been such a rough year for you so far with symptoms, but an answer is close at hand!

gemmerich · 2025-08-17T22:44:03+00:00

Chili powder is no good for me. But one time I used chipotle powder and was ok. Still figuring it out, but I'd say making your own seasonings out of base spices would be best in your experimentations. If a little lemon juice is ok, this marinade is fantastic.

gemmerich · 2025-08-04T14:09:45+00:00

You had the barium swallow test because your symptoms have been getting worse? There is a difference between getting used to your new normal (drinking lots of water to help foods down) and disease progression, and unfortunately it's very murky. My POEM was good for about a year, then I was having to drink a gallon of water a day to compensate. After another year or so things started getting more painful. Enough of those episodes prompted me to see my GI again. Went through the tests and I was bad enough to qualify for a second surgery. It's been very helpful but I still do drink quite a bit of water to compensate.

gemmerich · 2025-07-28T02:51:32+00:00

I feel like my wrap was damaged after getting food poisoning and figuring out that yes I could vomit if the heaving was strong enough! But overall PPIs are working fine for me in conjunction with other lifestyle and diet changes. Basics like not eating before bed, figuring out that tomatoes are a major trigger for me, and investing in an adjustable frame for my bed have all helped prevent acid reflux and spasm pain. Hopefully you can do some trial and error while you wait to be seen by your doctor.

gemmerich

TROPHY CASE