My Achalasia Story

Manometry charts showing Achalasia subtypes

Achalasia is a disease of the esophagus, which attaches between your voicebox and your stomach.   Normally food is pushed through the esophagus with involuntary muscle contractions called peristalsis.   In rare cases, this behaviour fails for unknown reasons.  The result is difficulty swallowing food, and eventually liquids.  Patients with Achalasia usually experience significant weight loss, a lot of discomfort while trying to swallow, and must adapt their diet to softer and softer foods like soup and mashed potatoes.

I started experiencing Achalasia symptoms in May or June of 2015.  They progressively got worse, to the point that I couldn't drink fluids in March of 2016.   I had lost 25lbs, and had become dehydrated and malnourished by the time I was admitted to hospital for surgery that would mitigate the problem.

What I hope to Achieve with this Post

1. Summarize what happened for interested friends and family
2. Help increase awareness about this disease, as it is frequently mis-diagnosed 
3. Hopefully help others with Achalasia by sharing how my story unfolded

Beginnings

Achalasia has an incidence of about 1 per 100,000 per year, and a prevalence (how many people are living with it) of about 1 in 10,000.

Mine started in June of 2015 with the experience of being at a conference dinner table, and not being able to get food to go down properly.   This discomfort persisted for a couple weeks and I went to see my family doctor about it.      I had been experiencing pretty severe heartburn for about 6 months prior to this, or certainly chest pain that I interpreted as heartburn.

I was sent for a couple of tests over the summer - a Barium Swallow/Xray which showed "esophageal spasms" and not much reflux from my stomach.   The next test was to send a Endoscope (camera) down my throat, for which I was mercifully sedated, and it showed nothing out of the ordinary.     I was seeing a Gastroenterologist by this point and he was convinced it was acid reflux - often clinically called GERD.    We managed to get these tests done relatively quickly by being available at short-notice for cancellations.

My wife and I were of course doing our own research, as it was persistently uncomfortable, and I had been limiting my diet to try to get relief from the reflux and discomfort.  Achalasia is rare enough that  it is often misdiagnosed as GERD, and this happened in my case as well.   Thanks to the help of this great blog by an engineer in Ontario, my wife identified correctly that my symptoms sounded a lot more like Achalasia than GERD.

This was in August.  The most frustrating part of this whole experience was the waiting for further tests, appointments and stages.  For example - we were sure it was Achalasia in August, and it took until the end of February for my turn to get the definitive test that would confirm Achalasia: esophageal Manometry (examples of the results pictured above).   During that time I had gone from discomfort - eating softer foods over the course of an hour  - to being reduced to 3 to 4 boost-type drinks per day with hopefully some soup and/or well-mashed potatoes with gravy.

Diagnosis

At the end of February, the Manometry test confirmed what Lauren and I were already certain of:  Achalasia.  Fortunately we had done our advanced reading and so were aware of the options and ready to go to the current best practice treatment which is a Heller Myotomy, with a Dor Fundoplication.

Unfortunately, there was more waiting (and corresponding suffering for myself, my wife, and my extended family) in the non-urgent stream of the Canadian medical system.   I'm a fan of our system in general, but waiting at sometimes becomes unbearable.  By this point many in my family were getting quite worried, as I was now down 25lbs, and at times unable to eat even soup.

 Surgery

My surgery consult took a couple of weeks to be scheduled,  this initial appointment to discuss options with the surgeon was 5 weeks after the manometry test, with the prospect of having the surgery 5 to 8 weeks after that.  Unfortunately my ability to take in fluids and nutrients had continued to deteriorate, to the point that I went to emergency in later March, as I was unable to take in fluids and had become both dehydrated and deficient in nutrition (as well as sleep).

I was not sleeping several nights a week because food that had not gone down would come up in the middle of the night, waking me up to choking on it every 20 minutes or so.

I was admitted as an emergency patient because I was no longer able to get enough nourishment down, and put on an internal hospital waitlist for the surgery.  After another 5 days of eating & drinking absolutely nothing except for IV fluids,  I had the surgery in time for Easter.

Current Situation

I'm currently 2 weeks post operation, and already feel significant improvement.  I'm able to eat soft foods, including one of my favourites - Shepherd's Pie - as long as the quantities are kept small.   I look forward to returning to a mostly normal diet.

HeadsUp Drive: New Website!

HeadsUp Drive - the simple driving app - has a new website - www.headsupdrive.com

Check it out for all you want to know about HeadsUp Drive (and perhaps a bit more.)

There are details on my favourite Windscreen Mount, a video of the app in action, and an explanation of why it is Google Maps, but better.

I made HeadsUp Drive because I found Google Maps, Apple Maps, Waze, and the rest of the competition I tested to be to cluttered for everyday use.

You can download HeadsUp Drive here now -  I hope you enjoy it & please recommend it to your friends!

Airplay Delay

Inspired by Allan Pike's naming and describing of Schrodinger's Shift Key, I'm writing this is to document my second most disliked change in iOS7 that regrettably has not improved in iOS8.

In a nut:  It used to be a lot quicker to flip music to Airplay speakers.  Prior to iOS7, Airplay used to engage with 2 quick taps.  Now it takes a full 5 taps & swipes to achieve the same result.

Two Taps on iOS6

Remember these two screens?

The airplay button automatically appeared if airplay speakers were available.

1. Tap the Airplay Button
2. Tap the Output you want

The screen dismissed automatically & you were on your way.

Five Taps on iOS7 and iOS8 

These three screenshots depict the five taps & swipe process of getting music to airplay speakers since iOS7.  The steps are:

1. Swipe up to access the Control Center.
2. Look for Airplay button and Tap
3. Tap the Output (Apple TV)
4. Tap Done (and wait...)
5. Tap the top of the screen to dismiss Control Center.

It's substantially slower, and I'm disappointed they didn't improve this on iOS 8.  I have submitted this feedback to Apple through iPhone Feedback, and I encourage you to do the same.

HeadsUp Drive

HeadsUp Drive is the driving companion app that I have been wanting, and have now successfully made for myself.  If you are looking for a simple, minimally distracting app to use on your daily commute or on roads where you don't need a route calculated for you -  I think you will like it.  Want to try it out?   You can download it from the app store for iPhone & iPad.

On first launch, most people notice that it's not very complicated.   That is entirely on purpose.  I have been wanting a simple app that I can just launch as I leave work and not have to do too much to use it.

I've tried  Apple Maps, Google Maps, Waze, and a few others.  My principal complaint with them all is that they take too much fiddling to use them day in & day out.    Often with those apps, they require  adjusting the view so that I can see the sections I need to (the same ones every day) and Waze too often prompts me for input, when all I want to do is just drive home efficiently.


HeadsUp Drive is a simple driving companion, designed to let you see the road ahead.  I think it's the the best, simplest app for everyday commuting.  It shows you Google Maps traffic and a chase-plane view so you can see what's coming, and plan ahead to avoid traffic jams.

There is very little interaction, and that's on purpose, because we should all keep our eyes on the road and hands on the wheel. The view adjusts automatically to show the traffic and roads in your direction of travel.

+ and - to zoom in and out, and a "?" button to remind you why the app is so simple.  It's designed to be simple!


I use it daily on my commute to & from work.  Below is a picture of it in action.  I hope you find it useful too.

Feedback and comments are welcome at: duncan@wilcock.ca

A Better Bike Computer: My Ideal Biking App & Sensor System

I bike a fair bit around Vancouver. I'm not in to wearing spandex, and would classify myself as somewhere around the casual-commuter biker.   I don't really care about all my speed, cadence, and heart-rate stats, although that could be interesting, and I refrain from thumping the hoods of cars in anger - except maybe if I was actually hit by one.

I am however a bit of a geek - especially when it comes to my iPhone & tracking things in general. Unfortunately my many attempts at using XCode to write iPhone apps have not been very successful, and I find myself being able to conceive of what I want, but unable to implement it.  (Update:  I spoke too soon, and have now built an app that is on the app store - HeadsUp Drive)

Since I believe that ideas themselves are not worth nearly as much as good execution, I've decided to offer these ideas to the inter-tubes and hope that if anyone finds them of benefit, they let me know (duncan@wilcock.ca) - especially if this biking device & app I want to buy ever gets made - by you or anyone else.

With that pre-amble, I'm going to launch into what I'm looking for.

A Better Bike Computer

Principally, I'm looking for a better bike computer.  A hardware device that is quite simplistic.  It can look similar to the $30 one I bought from MEC.  In fact, it should cost much more than between $50 to $100, because anything that I am going to strap to my handlebars can't be worth much more than that or it becomes more & more of a problem when I wipe-out and it gets damaged, or forget to remove it when I nip into a coffee shop and it gets nicked.

So that's price.  I'll leave promotion to you, place is clearly where I live (Canada please!) and now on to product.   (Four Ps of marketing reference for all you geeky business-school types)

Interactionless Tracking

The key attribute I'm looking for is Bluetooth LE connectivity to talk to my iPhone.   For inspiration, I'm looking at Automatic - a simple device that plugs into your car,  and an app that doesn't need launching, but that tracks your driving for you whenever you start driving.   It has other features and looks like a very cool product that I would already have if it were available in Canada.

That's it in a nut.  I don't want to have my iPhone attached to my handlebars, it's too expensive to put there, and more importantly - too much trouble to do every time.  Even launching an app is too much trouble to do every time - I just want to get on my bike and get to work, or wherever else I'm going.   But if the data was collected automatically - how far I went, what routes, and how fast.  It would be fun to sit down in the evening and look at it from time to time.

I think this is the key for tracking apps.  I'm interested to record & look at the information, but as soon as it becomes an additional thing to remember to do, the likely hood of me (or many others) using it regularly falls off a cliff.

Yes - I've seen the Wahoo Fitness Computer, but it gets the solution backwards, to my taste.  The data is collected by your phone first, and this Wahoo display is more like a second screen for the app, and I believe the app has to be actually running.    I'm saying that the bike-computer should record the information and be the principal interface with the sensors, and the app should connect to the bike computer automatically (Automatic uses iBeacon for this) & store the information long term for later review.  For the record - I don't care about wireless sensors (wired are cheaper & in general more reliable), and reliability is key.  If it adds a bit of weight or wind resistance - so be it, I'll get more exercise.

Bonus - Power my Lights

 A great added value or upsell feature for the commuter like me, would be some extra battery capacity and wiring to power my bike lights.    Then I would only have one thing to remove from my bike, take inside and charge up from time to time.


So that's it - my wishlist, the product I would like to buy, but have not yet seen on the market.  If you like the idea, and want to make it real - please do so.  I'd be more than happy to help.  I've got circuit-card layout skills, basic app making skills, and marketing skills - here's an example:  www.headsupdrive.com

Taking a Guess at Worldwide Energy Savings from Apple's new Mac OS X - Mavericks

Apple's newest operating system increases battery life by 25% to 30% with a simple software update.   Rolled out to around 50 million Mac computers, this increase in energy efficiency is going to add up to a lot of reduced  energy consumption and greenhouse gas emissions.  I'm going to try to calculate just how much.

It was the above graphic from John Siracusa's excellent review of the newest Mac Operating System OS X Mavericks, that really grabbed my attention. To increase the battery life by between 25% to 30% as John measured, the system must use power more efficiently - 25% more battery life means 1/1.25 = 20% more efficient.

I'm going to walk through a few more back-of-the-envelope calculations and to take a guess at how much electricity and green-house gas emissions that will add up to in the next year.

According to Horace Dedieu of Asymco Apple had sold 122 million macs in all time in February of 2012.   Let's conservatively estimate that those sold in the last 5 years are still in use - this equates to about 50 million - a few more may have sold since then, but it's a nice round number, that I used in my opening paragraph, and as I said in the title - this whole article is a big guess.

Another big guess is the adoption rate of Mavericks.  This year the upgrade is free, and adoption is expected to be unprecedented for a desktop OS.  One source is currently quoting 17% in under a month from Maverick's release date.  I'm going to pick 20% as a nice round number for the first 2 months after it's release.

Moving on to GHGs

It's at this point, that I realize I don't have a good figure for average energy use for a laptop during it's lifetime.  I could assume 8 hours per day, 50 weeks per year, for a lifetime of five years, but I think usage of computers varies widely, and the people who probably know best how much an average person uses their Mac is probably Apple.


Then I remembered that Apple provides some first class sustainability and environmental impact reports on it's website.  There are impact statements for all it's products, as well as the environmental impact of the organization  - including the life-cycle of it's products including use.   They chalk-up 30% of their carbon-footprint as due to product use - and they even provide the figure of "9,306,000 metric tonnes of greenhouse gas emissions."

Digging a little deeper into those product impact statements.  I see the most popular Mac Laptops at 350kg of CO2e for each computer and between 17% to 33% of that due to customer use (electricity).   A recent iMac is put at 1000kg of CO2e - 50% for customer use, and an iPhone 4s at 55kg and 25% of that for customer use.

Apple sells an overwhelmingly large number of iPhones as compared to the number of Macs sold, but from the impact statements we can see that the Mac Laptops use 6 times as much energy as iPhones.

It's hard to be precise on this, so I'll make another guess that Mac Laptops are responsible for about 50% of Apple's product use GHG emissions, or 4,653,000 tonnes of GHGs.

Unfortunately for me, since I'm most interested in energy savings in kWh (saving energy is what I do for a living) I don't know the conversion factors and assumptions Apple made in determining these GHG totals.  Still, estimating how many GHGs will be saved is an equally interesting figure to me, so I will continue.

Putting the Guess Together

Going with my 20% adoption rate by the end of 2013, the computers that will now have Mavericks on them would have been responsible for 930,600 tonnes of GHGs.

In 2014, but using power more efficiently, these machines will only generate 744,480 tonnes of GHGs for a savings of about 186,120 tonnes.

There we did it - a back-of-the-envelope guess, but it could be in the ballpark.   With one software update, by providing better battery life and making it's operating system more responsive, Apple has also eliminated 186,000 tonnes of greenhouse gas emissions per year.

Perspective on 186,000 tonnes

To put this in perspective, a person living in British Columbia, Canada generates on average 5 tonnes of GHG emissions each after all the driving, keeping our houses warm, and sending things to the landfill we do each year. So that's the carbon footprint of a small city of 37,000 people.

Here's another datapoint for comparison: the BC government tracks it's greenhouse gas emissions and offsets them for carbon neutrality.  In 2012 all the provincial government, schools, advanced educational institutions, and health-authorities reported using a total of 845,212 tonnes.

So one software update that saves 186,000 tonnes per year is as significant as it is impressive.

Amazing Tech in America's Cup

As a lover of amazing tech, I have been quite smitten by the America's Cup coverage.  There is of course lots of great new tech used in the boats like carbon-fibre hydrofoils and faster-than-the-wind speeds that I'll elaborate on in a future post,  but first I want to highlight the tech I've noticed in the video coverage, onboard the boats, and the interactive spectator apps.

Like so many things - it's best to start with a picture:

The lines on the water aren't there in the real world of course, but in the video feed they are overlaid & updated live.   This makes watching so much more interactive - for instance the speed of each boat is shown, and if you look closely there is a faint track that shows where the Italian boat has just been.

The significant lines for the course are shown to make it easy to understand where the course is - details like the circles around the marks/buoys, the distance lines, and faintly to the right of the screen is a wide line that indicates the course boundary.  Obtaining all this information in real time and then plotting it on the screen in a way that is unobtrusive, informative, and tasteful is amazing to see so well done.

Dirty Wind

The green lines are implemented with GPS transponders on the boats that relay the exact position, boat speed, and many other parameters back to the central race-control and television computers.

An example of an additional parameter the race-control & television computers have at their disposal is the wind speed and direction.  Combined with computer models of how the wind flows around the sails results in the amazing visualization of 'dirty-wind' shown below.  Dirty wind is air flow that is disturbed by the upwind sail and as a result will transfer less power to a boat downwind of the disturbances.   Here is how it looks in the video coverage with the blue enhancements from the Italian boat that are close to disturbing the Swedish boat.

Live On-board Cameras

Not content to watch from the many helicopters that are circling the boats, there are several onboard cameras (with windshield wipers) to give great shots of the action up close.  Audio from the crew communication systems (essential at the 80km/h speeds they are travelling) is patched in to the coverage, which brings us even closer to the action. Here is a great shot of the Italian team flying on their foils on a downwind leg:

Companion iPad App

I mentioned spectator apps.  As you might expect from San Francisco & the Silicon Valley Tech Titan - Larry Ellison - who deserves credit for the vision and funding of so much of this year's America's Cup, there are companion iPhone & iPad apps for spectators.  They are useful as aggregators of news, video footage, schedules, and results.

Not content with just those functions, the telemetry of each race is used to create a video-game like representation of the actual race that you can follow along with live, or once the races have been uploaded to youtube.  They call it 'Virtual Eye', and you can see how much it looks like exactly like the overlays in the television coverage.  The side bar at left allows you to add additional information that they don't normally complicate the television coverage with.

It's amazing, a real, usable example of interactive, second-screen television that adds to the experience of watching the event.

If you haven't seen one of the races yet - download the iPad app & follow along, or watch this recent race between Italy & Sweden I'm not regularly a sports-fan, but I've sure been enjoying the America's Cup this year.

My First Ride in a Tesla Model S

Had my first ride in a Tesla a few days ago, and as you might expect - I was pretty thrilled.  So much so that I thought I would capture a few of the aspects that impressed me most.

Amazing Screens & Software

You might expect from my post about the cons of dashboard screens in cars that this wouldn't be at the top of my list.  I maintain that these screens will be obsolete before the car has served it's useful life of 10 years or so, but I was definitely marvelled by these beauties.

The centre screen is a 17" glass covered touch screen that looks, feels, and responds iPad like (in my brief experience)  The resolution is excellent, and the software finely crafted.    The most quintessential wow moment?  Opening the sunroof by swiping a picture of it in the desired opening direction, and having it animate along with the physical roof.   Intuitive, effective, and well executed.

Swappable Batteries

This is my favourite new fact about the Model S.  Announced last week, the battery can be swapped out by an automated system in 90 seconds - faster than it takes to fill a gas tank.    The video below shows it in action.




I think this is exciting because without swappable batteries, electric cars will only be suitable as a second car for around town for the foreseeable future.

Gasoline is very energy dense, much more so than batteries. For example:

Smallish Gas Tank = 50 Litres of gasoline = 1.7 GigaJoules = 472 kWh
This is about how much your clothes dryer uses in a year.

For comparison - a small Tesla S battery = 60 kWh.

To charge the small Tesla S battery in 1 hour would take 100 Amps at 600 Volts.  This is quite a draw - a significant industrial machine with big throw switches uses this sort of power.

To charge it in 5 minutes would require:
100 Amps at 7200 Volts = 720 kW
This is the kind of wallop you get when a lightning strike hits, or is drawn daily by a pretty large office building.

There are plenty of chemical reasons why current battery technologies don't charge that fast, but you can imagine it will be quite a while before the electrical grid is able to deliver this type of capacity.

Smooth & Quiet

I'm sure it has been written more eloquently elsewhere just how smooth and quiet the ride is in the Tesla S, but it's one of those experience-it-to-understand it things.  No gears to switch through, no electric whine, just a smooth, solid ride.

Trunk and Bonnet Space Galore

The electric motor is compactly positioned in the rear of the car.  That leaves all the space the engine used to take up under the hood and plenty of space in the rear as well.  You might have imagined this would be the case, but it really is amazing to see.

The engine, the radiator & cooling system, exhaust system, and especially the transmission take up a lot of room in a combustion-engined car.  With these systems gone, there is all the room in the front of the car for storage, and inside the car where the hump from the transmission is usually - is eerily, but pleasantly empty.

Apple's Social Network

Ping - Apple's first Music focused social network -  didn't work out so well, but slides and features of iOS7 announced at WWDC 2013 are demonstrating that Apple is stealthily building it's own social network - one that perhaps does everything most people want, and a lot less that many don't want.

300 Million Accounts

A slide Tim Cook splashed up on screen at WWDC - and the bold statement he made - faster than Facebook to reach it.

iMessage & Game Centre

Tim Cook talked about these two things that Apple does "that are social" at All Things D a couple of weeks prior to WWDC. He may have said that he never felt Apple needed a social network, but I think Apple is hedging it's bets by building one anyway.

Find my Friends

A super useful app that let's you see where your friends with iDevices are on a temporary or permanent basis.  This location sharing is a great application, and something that Google, Facebook, Foursquare & others have been trying to crack for a few years.  I know I haven't been able to get my friends interested in the services of the other guys, but I have been able to get groups of 5 to 10 to sign on to use Find my Friends.   This is an example of an Ad-hoc Social Network - an interesting, and useable evolution of the social networking phenomenon.

Shared Photostreams

Sharing photos is a major application of social networking.  One of the main things people do on Facebook, and one key reason Facebook bought Instagram. Photostreams are much more private though - which a lot of users will find more appealing- certainly members of my own social circle that decidedly don't use Facebook are enjoying posting and commenting on Photostream photos.  Shared Photostreams - where multiple users will be able to add photos to the same album in iOS7 is a new & better experience than single person albums. Using Photostreams with my friends the past year many asked this same question - "Oh - can we just add them all do the same Album?"  - It's an obvious &  desirable use case.   Even better, it makes it easy to then save full resolution copies of the photos direct to your iPad or iPhoto on your Mac.

No Wall, Intrusive Games, Facebook Apps, or Advertising

I like Facebook for the most part, but frankly - it's a bit noisy. In fact taking over the photosharing will make the chatter stand out that much more. Social networking may segregate into chatty places & quieter - more private places. Places for photosharing, for location sharing, and for less intrusive gaming.   It's already a little narcissistic when we post our photos on Facebook, it may begin to appear even more so in future.

iTunes Radio

Photos are a big social sharing application, and music is too as were seeing lately with Songza, Pandora, Rdio, and Twitter Music.  Ping didn't work out so well, and I haven't had my hands on iTunes Radio yet to see for myself, but I'll bet that there will be social features baked into iRadio that continue to expand Apple's social relevance.

Hiding in Plain Sight

Put all this together and I see that like so many times before, Apple is rolling - quietly working away on something very big - almost unnoticed in plain sight.

Great Tech at Vancouver Nighthawks First Game

The Nighthawks - Vancouver's new professional ultimate frisbee team - had their first game this past Saturday at UBC's Thunderbird Stadium.   It was a great night - beer in the stands, an energetic crowd of a thousand or so, good friends, and of course an exciting game to watch.  I am looking forward to going again soon!

What was also fun was the great tech the Nighthawks and the Major League Ultimate organization have employed to put on the show.   I thought I would itemize some of the tech I noticed:

Slick ticketing from TicketLeap 

This is the first time I've seen or heard of Ticketleap and it worked really well for me.  Online ticket purchase, with a discount code an hour prior to the game.  The tickets were really one-time use QRCodes - one of them is at right.   I took a screen-shot on my iPad, and sent it to my iPhone for easier use later.   Their digital nature came in very handy when our party was split up enroute - I was able to just email the other people their tickets.  The future has finally arrived!

Ticket Entry System: An App from Ticketleap

I wasn't totally sure how it was going to work out when we got there, but sure enough the admission system worked well.  They had an iPhone at the entry gate running the Ticketleap app.  The camera on the phone recognized the QR code and confirmed our tickets.  Smooth, efficient, and you have to admit - pretty cool.

Square - For Souvenir Purchases

True to the technology-on-parade spirit, when it came to buying a few souvenirs later, out came the iPhone as soon as I produced my credit card.   Square is a neat system from the founder of Twitter, that was released in Canada 6 months or so ago, but this is the first time I've actually bought something with it. Your credit card is scanned by a little attachment to the phone, you do your signature on the touchscreen, and voila - your money is spent.

Live Streaming

For the away games, Major League Ultimate is streaming games live - for laptops and iPads alike.  It has been a bit glitchy so far, but the promise is exciting. 

Quadricopter with HD Camera

By far the most fun piece of tech was the quadricopter flying around the field, working on getting some close-in  aerial footage of the game.   They were playing it fairly cautious for this first game, but you can see it in the top left of this photo: 

What's so cool about quadricopters?  Check out this video of two autonomous quadricopters juggling.

Those were the coolest pieces of tech I noticed, but feel free to mention others in the comments if you are so inclined.  Also a quick shout-out to star player #45 - Allan Cowan - who is the main reason I made it to the game.  He had some pivotal plays on Saturday night, and his wife & kids were a cheering up a storm!

Update 1-May-2013: It was a hexa-copter (6 propellers) not a quadricopter, and here is footage from it with #45 Allan Cowan hucking for the goal.